Question:
From the case history below what is your conclusion?
- 65 year old man.
- Diabetic for 35 years. Significant diabetic complications: Bilateral below knee amputations and registered blind.
- Seen at routine diabetic out patients clinic.
- Had complained of feeling lethargic and out of sorts for 4 or 5 days. Blood sugar had been running high and was 16.1 mmols/L at clinic.
- BP was 176/108 mmHg
- Was short of breath at time of clinic attendance. Chest auscultation revealed widespread crepitations in both lungs.
- 12 lead ECG was requested.
- Cardiac Troponin T was elevated.
- The rhythm is sinus rhythm, rate approximately 75 per minute.
- The cardiac axis is normal.
- The most striking feature is ST elevation in the chest leads V1-V4.
- There is T wave inversion and pathological Q waves in V1-V3.
- The changes are suggestive of Anterior Septal ST elevation myocardial infarction (STEMI)
- However this patient has not presented with classical symptoms of STEMI. Most notably there is an absence of chest pain, generally the cardinal feature in these patients.
- This is likely a “silent MI” presentation, not uncommon in diabetic patients.
