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 carvedilol