A 57-year-old man presented to the emergency department with persistent diffuse ST elevation (STE) after failed treatment with streptokinase therapy that was administered the day prior (the onset of chest pain to lytic bolus was 8 hours). The pain was persistent, radiated to the back, and was exacerbated by coughing. He had normal blood pressure (100/60 mm Hg), mild dyspnea with bibasilar rales (22 breaths per minute), elevated jugular venous pulse, and pericardial friction rub. A 12-lead electrocardiogram (ECG) was obtained (Figure , A).Question: What ECG characteristics help distinguish STE myocardial infarction (STEMI) from the simultaneous occurrence of pericarditis and STEMI?

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Infection of Staphylococcus epidermidis is still a common problem in many hospitals. Factor determining biofilm formation makes it harder for atibiotics to cure the infection. Roselle (Hibiscus sabdariffa), a well known traditional medicine plant, is a potential candidate as a drug againts infectious disease. The purpose of this research is to investigate the antibacterial effect of ethanol extract from Roselle (Hibiscus sabdariffa) calyx againts the growth of Staphylococcus epidermidis. Assessment for antibacterial effect is performed using broth diffusion method. The extract is made by maceration of the calyx of Roselle in 96% ethanol. Extracts with concentration of 125, 62.5, 31.25, 15.63, 7.81, 3.90, 1.95, 0.97, 0.48, 0.24 125, 62.5, 31.25, 15.63, 7.81, 3.90, 1.95, 0.97, 0.48, 0.24

Patient: Female, 45-year-old Final Diagnosis: Isolated posterior ST-segment elevation myocardial infarction (STEMI) Symptoms: Atypical chest pain • a burning sensation in the left chest • radiating to both arms • back and legs Medication: — Clinical Procedure: Primary percutaneous coronary intervention (PCI) Specialty: Cardiology Objective: Challenging differential diagnosis Background: Guillain-Barré syndrome (GBS) is an autoimmune demyelinating disease that affects peripheral nerves and may be associated with nerve pain in the upper limbs and chest. Autonomic dysfunction in GBS can result in electrocardiography (ECG) changes that include T wave inversion, ST segment depression, or ST segment elevation. Recently, GBS was been recognized as a neurological consequence of COVID-19. This report describes the challenge of emergency diagnosis of posterior myocardial infarction (MI) in a 45-year-old Javanese woman who was known to have a 1-month history of COVID-19-related Guillain-Barré syndrome. Case Report: We report the case of a 45-year-old patient who presented to the Emergency Department (ED) with atypical an-gina. She had a history of GBS that started 2 weeks after she developed COVID-19. Since then, she frequently had pain in both legs and occasionally in the chest. Her electrocardiogram revealed subtle ST segment depression in the anteroseptal leads (V1–V4), along with ST segment elevation in the posterior leads (V7–V9). Cardiac marker (troponin I) was elevated and posterior regional wall motion abnormality was present on an echocardiogram. Coronary angiography revealed total occlusion of the first diagonal branch of the LAD, followed by deployment of drug-eluting stents to achieve good angiographic results. The patient was diagnosed with GBS and isolated posterior ST segment elevation myocardial infarction. Conclusions: This report shows the importance of performing standard cardiac investigations for myocardial ischemia or infarction in patients known to have Guillain-Barré syndrome so that the patient can be treated appropriately and urgently to ensure the best possible outcome.

Electrocardiography is the fastest bedside tool for rapidly identifying patients with acute coronary syndromes who require emergency reperfusion therapy. Some of the circumstances that make identification more complex are bundle branch block patterns. ST elevation in the right bundle branch block (RBBB) can still be detected, but the left bundle branch block (LBBB) must use specific criteria such as Sgarbossa and Barcelona. We present a patient with anteroseptal ST-segment elevation (STEMI), total AV block (TAVB) with ventricular escape rhythm RBBB pattern, and then turned into a LBBB pattern. Fortunately, it immediately turned into sinus rhythm after reperfusion therapy. It is essential to be able to identify STEMI in patients with BBB patterns. In addition, to provide the best possible outcomes for the patient, we must understand that the best way to manage STEMI with TAVB is to immediately install a temporary pacemaker and initiate reperfusion therapy.