Hospital Course and Discharge

Our patient's hospital course was uneventful. Her admission laboratory data had revealed an increase in her cardiac biomarkers. Both creatine-kinase and B-fraction and troponin levels were compatible with her diagnosis of an acute myocardial infarction. A follow-up echocardiogram demonstrated an increase in her ejection fraction.

Our patient's further management was initiated prior to discharge. She was advised to stop smoking, follow a low salt, low saturated fat weight loss diet and begin a lipid lowering agent. Because of her history of GI bleeding, she was begun on a proton pump inhibitor. To inhibit platetet aggregation, aspirin and clopidogrel were continued. She was also instructed in the use of nitroglycerin for chest pain. To lessen the risk of future cardiovascular events, an angiotensin converting enzyme inhibitor and an aldosterone antagonist were added to her beta blocker. She was also enrolled in an outpatient cardiac rehabilitation program and was scheduled for further follow-up evaluation in clinic.

Follow-up visit

Our patient returned in six weeks for a follow-up visit. She was asymptomatic with no evidence of heart failure. An echocardiogram showed mild anterior wall hypokinesis with an ejection fraction of forty-five percent, indicating that most of her initial left ventricular dysfunction was due to ischemic, or "stunned" myocardium, and not frank infarction. Her urgent reperfusion had successfully preserved her myocardial tissue. "Time is muscle."