title: Acute coronary syndrome.
abstract: The paramedics brought a 60-year-old man to the emergency department after a sudden onset of shortness of breath with a subsequent drop in the Glasgow Coma Scale (GCS). On arrival the patient looked peri-arrest. His O2 saturations were 84% on 15 L of oxygen. He had gasping breathing with a completely silent chest and the GCS was 6/15 (E=1, V=1, M=4). The blood gas revealed type-2 respiratory failure. The chest X-ray was unremarkable and ECG was not indicative for cardiac catheterisation lab activation. Bedside shock scan was done which showed global hypokinesia of the left ventricle. In spite of unconvincing ECG and chest X-ray, an acute cardiac event was diagnosed in view of an abnormal bedside echo. The patient was transferred to the cardiac catheterisation lab for urgent percutaneous coronary intervention which revealed critical stenosis of the left main stem coronary artery, which was successfully stented. The patient had a good recovery from the life-threatening event.
authors.affiliation: Emergency Department, Leicester Royal Infirmary, University Hospital of Leicester, Leicester, UK.
authors.forename: Saad
authors.initials: S
authors.lastname: Jawaid
authors.affiliation: Emergency Department, Leicester Royal Infirmary, University Hospital of Leicester, Leicester, UK.
authors.forename: Adeel
authors.initials: A
authors.lastname: Chaudary
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D004452:Echocardiography; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012770:Shock, Cardiogenic / Q000175:diagnosis*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000000981:diagnostic imaging