36 yr old male k/c/o DM. not on treatment , chronic smoker, alcoholic presented to ED we with H/o chest pain since 2hr , pain radiating to left arm , diaphoresis Bp-160/100 PR 112/MIN spo2 - 92% RR 20/MIN NECK Supple, no jugular venous distension. CARDIOVASCULAR: Tachycardic rate, regular rhythm, no rubs, murmurs or gallops. LUNGS: Clear to auscultation bilaterally . ABDOMEN: Soft, nontender, nondistended. EXTREMITIES: No clubbing, cyanosis or edema; radial pulses were rapid and weak. NEUROLOGIC: Nonfocal. The patient was placed on the cardiac monitor, a peripheral intravenous line was placed and a 12-lead ECG was obtained

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St depression and t wave inversion in inferior leads. . Poor r wave progression from v1 to V4 and Slight elevation of St segment in the same leads ..BOTH CAN BE CAUSED BY LVH. . LVH WITH STRAIN PATTERN PRESENT. . ST ELEVATION IN AVR PRESENT. ....THIS MAY B DUE TO LMCA OCCLUSION OR PROXIMAL LAD OCCLUSION OR TRIPLE VESSEL DISEASE. . FINAL DIAGNOSIS. . LVH WITH STRAIN PATTERN. .. ?OLD AWMI INFERIOR WALL ISCHAEMIA. . CARDIAC ENZYMES AND ECHO TO B DONE. . THEN CAG AND PROCEED. . MEAN TIME TREATMENT WITH HEPARIN AND AND ANTIPLATELETS AND STATINS. .

Anterior septal and inferior wall ischemia.
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St depression with t wave inversion in inf leads st depression in v5, v6 LVH with strain ( v2 ) St elevation in avr, v1 Lf main / three vessel dieases

SEMI Anteroseptal With Inferior wall Ischemia
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Well if at this circumstances Ecg 2 3 avf v5 and v6 St depression Coronary ischemic Rule out acute coronary syndrome Get cardiac marker And Angio Give nitrates and ace inhibitors Colpod a Rest as per investigation out come Remember pain to needle time primary ptca If cardiac enzyme panel raised trop t Cpk mb Risk factor 1.dm 2 . alcoholic 3.smoker Think cad

Acute anteroseptal infarction, st changes in inferior and lateral leads,it could likely to be reciprocal changes.Lt AD or circumflex disease,go for early PCI if in suitable center.

ST ELAVATION in avR, V1 S/o LAD Proximal occlusion or TVD GIVE LOADING DOSE OF ANTIPLATELETS And rush her for PAMI

ACS-AWMI with reciprocal inferolateral ischemia...send CBC..CPK-MB..TROP-I..RFT'S...LFT'S..LIPID PROFILE.. Rx S-metoprolol 50mg...clopidogril 75mg 4 ...2 disprin.. Atrorvastatin 40mg stat PO...sorbitrate 5mg S/L...for bp Depin 5mg s/L stat...iv NS- M drip 2D Echo required to rule out any hypokinesia...pul odema etc

Inferior+lateral wall ischemia treat on lines of non stemi--plan cag

SINUS TACHYCARDIA STEMI SEPTALWALL LATERWALL ISCHAEMIA

Old Inferior wall MI with triple vessels disease. Adv for 2 - D echo and go for CABG

ST depression and T inversion in inferior lead and st depression in lateral lead v5 -6 with sinus tachycardia B blocker and antiplatlet &antidiabetic

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