Cardiology Case Report: Elderly Man with Hypotension and Dementia

Article

Our latest cardiology case report from Brady Pregerson, MD, features an older man with dementia presenting with hypotension and brought to the hospital with a possible STEMI. Can you determine the correct diagnosis?

History:

A patient in their mid-70’s with a history only of dementia is brought from home to the hospital by medics as a STEMI for what sounds like a syncopal episode with persistent low BP. Medics state his initial BP was in the 60s but after 500ml of NS is in the 80s. His baseline is ambulatory but only oriented x 1-2, however in the past week he has been having generalized weakness and not getting out of bed. He was also having low grade fevers as well so they tested him for COVID and that was positive. He does endorse chest pain but it is unclear how reliable he.

Exam:

BP in the 80’s, HR a-fib at 145-ish, pulse ox 95% on facemask and temperature normal. Lungs sound clear on exam

An ECG is done:

EKG Printout for an elderly patient with an acute myocardial infarction | Courtesy: Dr. Brady Pregerson

Computer Read: A-fib with RVR, low voltage, ST elevation anterior, ***ACUTE MI***

What is the most likely cause of the diagnosis?


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