Myocardial Infarction: Case of Seeking Medical Attention


On March 20, 2022, a 55-year-old man sought medical attention.

The patient complained of shortness of breath with minimal physical exertion, increased heart rate, and elevated blood pressure (BP).

Shortness of breath and palpitations worsened even during conversation and slight movement, but diminished when sitting.

Medical History

Since approximately March 12, 2022, the man experienced weakness and fatigue, worsening shortness of breath occurring with less physical exertion than before. By March 18, weakness intensified, shortness of breath occurred with minimal exertion, a strong sense of breathlessness emerged, and BP increased. On March 20, the patient decided to seek medical help.

The man has been suffering from hypertension for over 10 years, regularly taking 100 mg of Aspirin (in the evening) and a combination medication consisting of 5 mg Amlodipine and 10 mg Lisinopril (1 tablet once daily).

Additionally, the patient has type 2 diabetes. He irregularly monitors blood glucose levels and takes antidiabetic medications. He has no allergies, and his tolerance to medications is unremarkable. His harmful habit is smoking 2.5 packs per day.

There is a family history of hypertension.


Upon presentation to the medical center, the patient’s condition was satisfactory. He was conscious. Pulmonary auscultation revealed vesicular breathing (normal) in the lungs, with dry rales heard bilaterally in the lower lung fields. Oxygen saturation was 96% (normal).

Heart sounds were muffled, with a regular rhythm and heart rate (HR) of 110 beats per minute. BP was 155/110 mmHg on the right arm and 150/100 mmHg on the left arm.

The abdomen was soft and non-tender. The liver was not enlarged. Bowel movements and diuresis (urine volume) were normal. No peripheral edema was noted.

Echocardiography on March 21 revealed myocardial infarction with an aneurysm at the apex of the left ventricle (LV), reduced LV contractility, a small amount of fluid in the pericardial cavity, and LV wall thickening, indicating a previous myocardial infarction.

Chest X-ray showed pulmonary vascular congestion.

The patient was referred to a cardiologist. An ECG revealed acute coronary syndrome with ST-segment elevation.

The patient was transported by ambulance and admitted to the emergency department of the Regional Clinical Cardiology Dispensary of Ryazan.

Primary: Ischemic heart disease: Q-wave anterior myocardial infarction of the LV (since March 12, 2022).

Complications: Chronic heart failure IIb with reduced ejection fraction (46%), functional class 4 (symptoms present at rest and worsen with minimal physical activity). Cardiac asthma. Post-infarction aneurysm of the LV apex.

Comorbidities: Stage III hypertension. Uncontrolled arterial hypertension. Atherosclerosis of the aorta, coronary, and cerebral arteries. Risk 4 (very high risk of cardiovascular complications). Type 2 diabetes.


Due to the elapsed time since myocardial infarction, coronary angiography was not performed.

Treatment was conservative:

  • Ticagrelor 90 mg twice daily;
  • Lisinopril 20 mg twice daily;
  • Atorvastatin 80 mg in the evening;
  • Aspirin 100 mg in the evening;
  • Metoprolol 25 mg twice daily;
  • Spironolactone 50 mg at noon;
  • Torasemide 5 mg in the morning;
  • Nitroglycerin spray as needed.

Subsequent blood tests led to a reduction in Atorvastatin to 20 mg in the evening, replacement of Lisinopril with Perindopril 5 mg twice daily due to decreased BP, and replacement of Torasemide with Indapamide 2.5 mg.

The patient’s condition stabilized with treatment. Venous congestion resolved.

After discharge, the patient quit smoking, lost weight, maintained proper glycemic control, and took medications as prescribed. He also underwent rehabilitation at City Clinical Hospital.

Over the year, the patient’s condition improved: BP decreased, and he could walk over 450 meters without stopping. However, despite treatment, there was no significant positive change in echocardiographic findings over the year, indicating irreversible heart damage.

This clinical case demonstrates that the outcome of myocardial infarction can be favorable even if the patient seeks medical attention 8 days later. The key is to follow all medical prescriptions, undergo regular examinations, attend appointments, and change lifestyle habits.

Although the patient’s quality of life significantly improved, his heart was irreversibly damaged. If the man had sought help in time, this would not have happened.