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Repeat CT angio chest (not CT coronary, unclear what protocol) showed possible LAD aneurysm and thrombus. Finally, coronary angiography was performed (at least 5 days after presentation) which confirmed LAD aneurysm with large thrombus burden, TIMI 0 flow, thrombectomy performed. Beware a negative Bedside ultrasound.
There are no Q-waves to suggest old inferior MI, or inferior aneurysm as the etiology of the ST Elevation. I suspect pulmonary edema, but we are not given information on presence of B-lines on bedside ultrasound, or CXR findings. However, there is also significant tachycardia , with heart rate of 116, and known hypoxia.
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