Managing Acute Coronary Syndrome Amidst Resource Constraints: A Nigerian Case Report
Keywords:
Acute Coronary Syndrome, Case Report, Nigeria, Resource ConstraintsAbstract
Acute coronary syndrome is a cardiovascular disease that is now becoming common in developing countries as a result of the adoption of a westernized lifestyle, high prevalence of hypertension, diabetes mellitus, and obesity. The diagnosis and management are challenging in low-resource countries such as Nigeria due to late presentation, diagnostic challenges, and financial constraints. We present the case of a 63-year-old woman, a known patient with hypertension and diabetes mellitus, who presented with a 5-day history of central crushing chest pain, with associated diaphoresis, vomiting, and preceding easy fatigability. An electrocardiogram (ECG) done at presentation showed widespread myocardial ischaemia, and troponin I was markedly elevated. The coronary computed tomography (CT) coronary angiography done showed near total occlusion of the proximal portion of the left anterior descending artery. A diagnosis of acute coronary syndrome was made. She was counselled for percutaneous coronary intervention (PCI), but she could not afford it. Guideline-directed medical therapy was initiated, and only two serial electrocardiograms were done. Due to financial constraints, there was a delay in getting a CT coronary angiography, inability to do serial ECG and cardiac enzyme monitoring and inability to have PCI, which is the definitive treatment of her condition. She improved with medical therapy only and was subsequently discharged.
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