75y old male known to be diabetic(type2), hypertensive, Heavy smoker and dyslipidemic .Presented by typical chest pain associated with sweeting , and excessive vomiting for 3 hours. In emergency department , patient crushed and his blood pressure became unrecorded.He was promptly transferred to intensive care unit on maximum vasopressors dose. His blood pressure was still unrecorded ,however. Patient ,then has been intubated and kept on mechanical ventilation .
His electrocardiogram showed ST elevation in lead I ,AVL , V2-V6 with right bundle branch block and Bed side Echo showed sever anterior, anterolateral , apical and septal hypokinesis and Ejection fraction was 10-15% .His Troponin was positive but all other labs were normal .
Coronary angiography through trans-femoral approach showed ; 100% left main thrombus occluded lesion .