Yashpal was a 59 year-old man, who ran a small mess for local students Infront of our hospital. He had always been a hard worker, trying to make ends meet for his family. However, lately, he had been facing a lot of financial troubles, and the burden was beginning to take its toll on his health.

One night, Yashpal was rushed to the emergency department with severe chest pain radiating to his left shoulder with profuse sweating. He described pain as a heavy, crushing, or squeezing sensation in the chest. It was feeling like a tight band around the chest with heavy pressure. He was a known case of Diabetes and Hypertension. He completely ignored both the conditions and never took any medicines for both of the ailments. I was on the duty that night. As soon as I saw him, I realized that we needed to act fast.

Upon examination, Yashpal’s Vitals were HR – 105bpm,  BP – 170/110 mmHg, RR – 25/min, Spo2 – 94%.

His random blood sugar was 350mg/dl on glucometer.  He was given sublingual Nitroglycerine dose of 0.4 mg every 5 minutes for a total of 3 doses to reduce the BP by 20%-25%. (Tab Myonit Insta)

We did ECG which shown 3mm ST segment elevation with pathological Q waves in II/III/avF leads. ECG suggested Inferior wall Myocardial infarction. We immediately did a triage test (Combination of Troponin I, CK MB and NTproBNP). Triage test reported negative for acute coronary syndrome.

Despite negative test, considering high suspicion and significant changes in ECG He was given a loading dose of dual antiplatelet therapy (DAPT), nonenteric-coated aspirin 325 mg with clopidogrel 300 mg and planned for Fibrinolysis.

Due to high suspicion and co-morbidities triage test was repeated again after 2 hours and test came positive on second time. Detailed blood workup for CBC, LFT, KFT, HbA1c, RBS, Lipid Profile, hsCRP, PT, aPTT were sent to the laboratory along with PA view chest Xray to rule out other causes of chest pain.

We talked to his family (wife and 3 daughters with no son) about cost of thrombolysis, somehow they arranged money for thrombolysis and without wasting our time we initiated thrombolysis.

The survival benefit is greatest when fibrinolytic agents are administered within the first four hours after onset of symptoms and particularly within the first 70 minutes. Thrombolysis was done with third generation thrombolytic regime