48 yo M. Sudden onset chest pain whilst sleeping. Looks very unwell. Patient was extremely anxious, hypotensive and grey in colour. Previous MI 2 months prior. No other medical history. Chest pain in central and pressure/heavy in nature, radiates to L arm and feels like he's going to die. Whats diagnosis?

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IHD ACS recent Evolved Anterior Wall MI with Inferior Wall Ischemia. Loss of R V1-V5, deep ischemic inverted T waves in precordial leads and inferior leads. Now recurrence of ACS. Needs Admission into CCU. further evaluation Repeat ECG Cardiac Enzymes Echo Coronary Angiogram and revascurisation ie PTCA & Stenting . Before that load with Aspirin Ticagrelor statins heparin nitrates and stabilise anxiety respirationO2 saturation Hemodynamics and sos Morphine, GpIIbIIIa inhibitors IV.
ECG. Sinus Mechanism. ST Elevated in inferior lead with T Inverstion. Q wave are in inferior lead. ST Elevated in Cheast lead with T Inverstion. 1. Extensive Antero- inferiorWall. MI 2. RBBB. With Brugada syndrome. 3.HOCM. Do 2D.ECHO AND cardiac markers
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NSR. Axis Normal. Incomplete RBBB. ST depression with convexity in V 3-6. T wave inversion in L 2 3 ,aVF and V 2 - 6. Interpretation : Sub Endocardial Infarction.
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T wave inversion in lead 2,3 avF, V1 to v6. Non Stemi... Send cardiac enzymes.. Loading dose of ANTIPLATELETS... 2D ECHO.. PREPARE FOR ANGIOGRAPHY ASAP.
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S.Bradycardia RBBB with secondary repolarization changes T wave inversion in inf leads & v3 to v6 Ischemia
NSTEMI ADV CARDIAC ENYMES START ANTIANGINAL &ANTIPLATELETS GO FOR 2D ECHO&CORONARY ANGIO
RBBB Inferio anterior infarct. ..?? HOCM LMWH Clopitab disprin statins Echo CAG
Non Q wave infarct along with incomplete RBBB Anti-platelet therapy with CAG asap.
Sinus bradycardia, incomplete RBBB, Right sided of the
Unstable Angina Chronic on acute Anterior wall MI
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