Beverly is a 78 year old lady admitted for elective (CABG) coronary artery bypass graft, following a diagnosis of three vessel disease has history of (CAD) coronary artery disease and (MI) moyacardial infarction, with previous history of PCI. On day 3 care post operation in high dependency unit (HDU) . Beverly complained of chest pain radiating from right shoulder accompanied by ST elevation on the ECG, hypoxia, dyspnoea, tachycardia and hypertension indication of possible post CABG MI.