Challenging case of STE( Is all STE due to coronary artery disease?Could it be due to valvular disease?)Challenging case of STE ( Is all STE due to coronary artery disease? Could it be due to valvular disease?)

Case:•۶۰ y/o female presented to ED due to chest pain and severe dyspnea FCIV from ۲ days ago•PMH:•Hx of AVR and MVR ۱۰ y/ago due to Rheumatismal valve disease•HTN•Vital sign:•BP: ۱۰۰/۶۰ HR: ۱۳۰ RR: ۲۴ o۲:۹۰•Drug Hx:•warfarin ۵/d ASA ۸۰/d losartan ۲۵/d carvedilolER ECG