MRCP2-0114
A 58-year-old man presented to the Emergency department with central chest pain that had been ongoing for an hour. He reported that the pain was similar to his previous angina pain. The patient had type 2 diabetes mellitus, which was poorly controlled. He had been admitted to the hospital four weeks prior with chest pain and was diagnosed with a non-Q wave myocardial infarction. During that admission, he underwent coronary revascularisation with a drug-eluting stent to his right coronary artery and had been taking aspirin and clopidogrel regularly since then.
Upon admission, the patient was clearly in pain, with a blood pressure of 105/65 mmHg and a pulse of 120 beats per minute. His jugular venous pressure was measured at 8 cm above the sternal angle. The first and second heart sounds were normal, with an added third heart sound. A soft ejection systolic murmur was heard in the second left intercostal space. Auscultation of the chest revealed fine inspiratory crackles at both lung bases, and there was no ankle swelling. The patient’s ECG showed gross ST elevation (4 mm) in the inferior leads with reciprocal ST segment depression in the anterior and lateral territories with T wave inversion.
What is the diagnosis?