35/f chest pain radiating to Left upper limb for 10 days and past h/0 ac. pancreatitis. dyspepsia+ .given pan-d, tramadol, antacid, but pain not subsides. no DM, htn. next step pls. advice

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ECG shows antero septal injury start tab clopidogril 300 tab disprin tab atorvastatin 80 stat and HS nitrates. multivitamin low dose betablock low molecular weight heparin routine blood investigation cardiac enzyme along with amylase USG abdomen for pancreatitis lipid profile plan for echo and COronary angiography

"T"INVERSION IN V1-----V6 ADV---CBC---TO R/O ANAEMIA ---ELECTROLYTES----TOR/O HYPOKELAEMIA/HYPONAETRIMIA ----THYROID STUDY TO R/O HYPOTHYROIDISM WITH IHD -----CARDIAC ENZYMES TO R/O IHD ------X-RAY CHEST &USG ABD. TO R/O CONDITIONS CAUSING RAISED DIAPHRAGM

St depression in v4 to v6 T wave inversion in lead 3, v1 to v5 T wave flat in v6, avf D / D Wellen's type 2 syndrome NSTEMI Subendocardial ischemia very unlikely but P.E should be kept in mind At this point best test is ECHO & if normal go for D dimer

definitely she has st t changes in inf.wall leads n marked in v2-4, she has definitely ihd, needs blood investigation cpk mb, as well echocardiography....the investigation tells us line of treatment

t wave depressrion in V2 v3 v4 . probably evolved ASMI. can heparinize (12,500usc bd)

looks like NSTEMI trop i Loading doses of aspirin, clopidogril,atorvostatin.

Along with cardiac enzymes, CBC, sr. Amylase, lipase ,2D Echo may help.

evolving NSTEMI Anterio septal wall,get troponin,thrombolize

sir can we thrombolyse without st elevation
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2d echoes, and CAG should considere

subendocardial infarction (NSTEMI).

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