59 year old engineer with history of smoking for 35 years at a rate of 5 cigarettes per day, dyslipidemia with hypercholesterolemia treated with pravastatin irregularly. He began his current condition for 6 months with chest pain, oppressive associated with moderate exercise. Four days before her admission he had increasing pain which occurred in rest of Intensity 8/10 irradiated to mandible and went to a General Hospital getting the following electrocardiogram.
He did not receive reperfusion therapy and took medical treatment for 3 days and subsequently transferred to our institution where he was asymptomatic and hemodynamically stable. The physical examination showed no jugular engorgement and the chest breath sounds were normal, no rales, the apex displaced to the 6th left intercostal space 2 cm outside the midclavicular line, a constant fourth heart sound, no third heart sound, non-audible murmurs or rub. The maximum peak troponin was 54 ng / dl and NT pro BNP level of 4220 pg / dl.
We begin the discussion of the case via Twtiter at 20 hrs of Mexico City.