Door time 10:45 BIBA 54yo male C/O chest pain since this morning Started while he was working in his garden, central crushing pain, radiating to the left side of his chest and his jaw was associated with DIB, intense sweating, and palpitations He does not complain of dizziness, cough or LOC had been having similar pain but less intense and ware waxing and waning, precipitated by exertion He mostly noted this pain while walking up hill and climbing stairs he had recently found it difficult to lie down flat and had been using more than one pillows to sleep at night on one occasion he was woken up in the middle of the night feeling breathless , had to get out of bed can walk around in his room before he could go back to sleep no recent h/o fever, flu like symptoms, cough and cold, pain while taking deep breaths or moving from side to side LAS: Administered Asprin 300mg GTN spray 800mcg Morphine 5mg PMH: HTN T2DM HChol CKD - I (baseline Cr 105) Meds: Amlodipine 10mg Metformin 1g BD Atorvastatin 20mg Allergies: Penicillin - Anaphylaxis S/H: Lives with wife and two kids Smoker Occasionally drinks Worked as a software engineer F/H: Father had Heart attack at the age of 60 Mother had valve issues Recent investigations: HbA1C: 64 T Chol : 5.6 LDL: 2.4 O/E: speaking full sentences, Sats 95% in RA pain 8/10, dull pain now WWP, good b/l pulses SBP : 126 JVP not elevated Chest: Good B/L AE, HS no murmurs, no palpable pain over precordium Abdo: SNT calves : SNT LAS ECG: Anterior STEMI, with reciprocal changes in post leads POCE: preserved LV, mild MR Impression: STEMI Plan: Admit O2 GTN spray PRN Morphine 5mg IV stat Load Prasugrel 60mg stat Cardiac monitor Bloods: FBC, U+E, Trop, G&S repeat 12 Lead ECG Prepare Cathab for pPCI IP Echo, CXR NBO If pain still persists, then start GTN infusion @ 2-3 ml/min and monitor BP