A patient with post-AMI HFrEF treated early with ARNI

摘要

Presentation and investigations: A 51-year-old male nonsmoker and nondrinker with good past health presented in June 2020 with resting chest pain for 2 weeks, which increased on the day of presentation, as well as dyspnoea on exertion. At presentation, the patient was diaphoretic, with a blood pressure (BP) of 90/55 mm Hg, heart rate of 120 bpm, SpO_2 of 94 percent on 2 L of oxygen via nasal cannula, and crackles heard over both bases of the lung. Chest X-ray showed pulmonary oedema. Electrocardiography showed sinus rhythm with ST segment elevation at leads V1-2 and aVR. Bedside echocardiography showed left ventricular ejection fraction (LVEF) of 20-25 percent, with severe hypokinesia over the anterior and anterolateral walls as well as mild mitral regurgitation. He was diagnosed with acute myocardial infarction (AMI), and was in Killip class III and New York Heart Association (NYHA) class IV.