36 yrs old male pt admitted with complaints of chest pain. ...1 day. . acute onset of chest pain during playing with friends. .. first ecg. .. During admission second ecg. .next day . ecg findings? Treatment? plz share your views. . Thanks in advance. ..

6 Likes

LikeAnswersShare

Dear friends. . Thank you so much for your wonderful answers and explanation .... When I went to our IMCU..I saw this pt .. Pt was admitted with the complaints of chest pain for one day and the first ecg was taken and treated by my friend as a case of CAD. UNSTABLE ANGINA. . FIRST ECG FINDINGS. . Lead 1 and AVL. .negative AVR LEAD. .upright. . Normal progression of r wave from v1 to v6. . ....LEAD REVERSAL. Biphasic T waves present in V2 TO V6. . WELLENS SIGN PRESENT. . PT WAS TREATED WITH IN. HEPARIN AND ANTIPLATELETS AND STATIN... NEXT DAY. .I SAW THAT PT .. Pt was sitting comfortably. ...when lying down he had chest pain aggravated. ... Then second ecg was taken. .. SECOND ECG FINDINGS. . ST ELEVATION IN MOST OF THE LEADS EXCEPT IN AVR AND V1. . ST ELEVATION IN LEAD 2 MORE THAN LEAD 3. PR SEGMENT DEPRESSION IN MOST OF THE LEADS PRESENT. SPODICK SIGN POSITIVE. RECIPROCAL ST DEPRESSION AND PR SEGMENT ELEVATION CLASSICALLY SEEN IN AVR. ... ALL THE FINDINGS ARE SUGGESTIVE OF PERICARDTIS. .. THEN RETROSPECTIVELY HISTORY WAS ELICITED. . NO H/O FEVER OR ANY RHEUMATOLGICAL DISORDERS. .. BUT PT HAD H/O RECURRENT SELF INFLICTED INJURY IN THE CHEST WITH HIS HAND WHENEVER HE GOT ANGRY. ... AFTER DIAGNOSIS OF PERICARDTIS HEPARIN STOPPED. . PT WAS TREATED WITH ASPIRIN 300MG TDS. .. TODAY PT HAS CHEST PAIN DECREASED. . ABLE TO LIE DOWN COMFORTABLY. . TODAY. .ECHO WAS DONE. .ECHO NORMAL. TODAY ECG WAS TAKEN. .. I WILL POST THE ECG FOR UR SUGGESTIONS. .. AGAIN THANKS A LOT FOR ALL THE PARTICIPANTS. ..

Awesome case...am saving this one..never expected self inflicted chest trauma...wow!!!thats a first...super diagnosis and management sir...
1

View 3 other replies

Dr. Suresh Narayanan Sir, First ecg first I thought it's dextrocardia since: Positive QRS complexes (with upright P and T waves) in aVR,Negative QRS complexes (with inverted P and T waves) in lead I,Marked right axis deviation are present.but am going for Left arm/right arm lead reversal sir because Absent R-wave progression in the chest leads with dominant S waves is not present. Rhythm wise also small irregularity is there.considering this I think its more of a anterolateral ischemic change.could be a Coronary Vasospasm (Prinzmetal’s angina)?? But then the second ECG: It shows all the signs of Pericarditis - Stage 1. Widespread concave ST elevation and PR depression throughout most of the limb leads (I, II, III, aVL, aVF) and precordial leads (V2-6). Reciprocal ST depression and PR elevation in lead aVR (± V1). Sinus tachycardia is also present either due to pain and/or pericardial effusion. It's not Benign Early Repolarisation(BER) - ST segment / T wave ratio is > 0.25 in V6 and no Fish Hook Pattern in V4.

Thank you dear Shigil for wonderful explanation
0

Dear friends. . Thank you so much for your wonderful answers and explanation .... When I went to our IMCU..I saw this pt .. Pt was admitted with the complaints of chest pain for one day and the first ecg was taken and treated by my friend as a case of CAD. UNSTABLE ANGINA. . FIRST ECG FINDINGS. . Lead 1 and AVL. .negative AVR LEAD. .upright. . Normal progression of r wave from v1 to v6. . ....LEAD REVERSAL. Biphasic T waves present in V2 TO V6. . WELLENS SIGN PRESENT. . PT WAS TREATED WITH IN. HEPARIN AND ANTIPLATELETS AND STATIN... NEXT DAY. .I SAW THAT PT .. Pt was sitting comfortably. ...when lying down he had chest pain aggravated. ... Then second ecg was taken. .. SECOND ECG FINDINGS. . ST ELEVATION IN MOST OF THE LEADS EXCEPT IN AVR AND V1. . ST ELEVATION IN LEAD 2 MORE THAN LEAD 3. PR SEGMENT DEPRESSION IN MOST OF THE LEADS PRESENT. SPODICK SIGN POSITIVE. RECIPROCAL ST DEPRESSION AND PR SEGMENT ELEVATION CLASSICALLY SEEN IN AVR. ... ALL THE FINDINGS ARE SUGGESTIVE OF PERICARDTIS. .. THEN RETROSPECTIVELY HISTORY WAS ELICITED. . NO H/O FEVER OR ANY RHEUMATOLGICAL DISORDERS. .. BUT PT HAD H/O RECURRENT SELF INFLICTED INJURY IN THE CHEST WITH HIS HAND WHENEVER HE GOT ANGRY. ... AFTER DIAGNOSIS OF PERICARDTIS HEPARIN STOPPED. . PT WAS TREATED WITH ASPIRIN 300MG TDS. .. TODAY PT HAS CHEST PAIN DECREASED. . ABLE TO LIE DOWN COMFORTABLY. . TODAY. .ECHO WAS DONE. .ECHO NORMAL. TODAY ECG WAS TAKEN. .. I WILL POST THE ECG FOR UR SUGGESTIONS. .. AGAIN THANKS A LOT FOR ALL THE PARTICIPANTS. ..

Thanks
0

View 1 other reply

ECG 1. NSR. RAD. ST depression and T wave inversion in L1 and aVL. Minimal ST elevation in L3. Biphasic T in V 4,5 and 6. Left anterior occlusion. ECG 2. NSR. Normal Axis. Widespread ST elevation. ST depression in aVR. Spodick's sign . Biphasic T in V 4,5 and 6. LAD occlusion with PERICARDITIS.

Thank you so much for your nice answer sir
0

View 1 other reply

ECG 1- t inv in leads 1,aVL, v5,v6; biphasic t inv in v3,v4- lcx and lad territory ischemia ECG 2- stemi in 1,2,avf,v4,5,6,aVL St elevation in lead 2>avf>3, so involved territory is dominant left circumflex artery mi Since these changes happened over 1 day,dd are 1. Mi, 2. Prinznetal angina 3. Stress induced cardiomyopathy ( takatsubo) If st elevation persists for weeks, dd would be ventricular aneurysm To do cardiac enzymes, cardiac catheterization, stress testing

Thanks dear Naveen
0

View 2 other replies

First ecg is wrongly placed limb leads Shows more prononced layral wall mi Second ecg shows Signs of impared myocardial reperfusion in lead avr with st depression With inf and latetal wall mi Occlusion of dominant lcx or rca Patient need urgent cath

Thank you sir
0

In the first ecg the lead LI is negative P, QRS and T and aVR is positive. This shows the either Dextrocardia or wrongly placed leads. In the second ecg:- ST elevation with q wave in lead III. And ST elevation is present in lead II, III, aVF with is concave upward. I think evolving MI inferior wall. With lateral wall MI.

Good observation sir.
0

View 2 other replies

Yes sir. .but I'm waiting for complete normal ecg within 2 days. . Then we will decide about CAG.. at present pt was comfortable .so no hurry I think. ... but if persistent wellens sign. .pt needs definitely CAG. . Thank you sir

@Dr. Yashpal Chadha sir
0

View 2 other replies

Gd eve sir.. 1st ecg anterolateral ischemia wt limb lead reversal... 2nd ecg .. anterolateral ischemia wt pericarditis... Sir..

Dear friends. . Follow up ecg was taken for that pt.. Now chest pain decreased. . ECG. ..ST ELEVATION RETURNS TO BASE LINE IN MOST OF THE LEADS AND PR SEGMENT DEPRESSION CAME TO NORMAL. .. T WAVE INVERSION PRESENT IN MOST OF THE LEADS. . IN LEAD AVR. ...PR SEGMENT ELEVATION AND ST DEPRESSION. . REVERTED TO NEAR NORMAL. PLZ SHARE YOUR COMMENTS. .. THANKS IN ADVANCE

Load more answers

Cases that would interest you