Case Summary:
A 58-year-old male with type 2 diabetes mellitus, hypertension, and hyperlipidemia presents to the emergency department with 2 hours of severe chest pain radiating to his left arm. He is sweating profusely and has nausea. His ECG shows ST-segment elevation in leads II, III, and aVF. He has a history of suboptimal glycemic control and is on metformin and atorvastatin.
Key Investigations:
- ECG: ST-segment elevation in inferior leads (II, III, aVF)
- Troponin I: Elevated (above the 99th percentile)
- Echocardiogram: Mild inferior wall hypokinesis
Questions:
- Based on the patient's presentation and ECG findings, what is the most likely diagnosis, and what is the significance of the ST-segment elevation?
- How does diabetes mellitus influence the pathophysiology of myocardial infarction, and what specific challenges does this pose in management?
- What is the role of early reperfusion therapy in the management of acute STEMI, and when should fibrinolytics be considered versus primary PCI?
- Discuss the pharmacologic agents you would initiate immediately for this patient upon diagnosis of STEMI.
- What are the long-term management strategies for this patient, considering his diabetes and cardiovascular risk factors?
References:
- American College of Cardiology (ACC) Guidelines, 2023.
- Fihn, S.D., et al. (2019). "Chronic Coronary Artery Disease: Management." Journal of the American College of Cardiology.