40 yeal male a known smiker and alcoholic with a prior h/o ischemic stroke presented with acute onset chest pain since 2 hrs serial half hr ecgs in cronolilogical order. Baseline markers normal. Patient given oral loading dose after 2 nd ecg and now pain free post sorbitrate. No htn no dm. Only 2nd ecg showed a upgoing st segment( slight) woth reciprocal changes in lat leads. Could it pe prinzmetal angina??

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Should hv been thrombolised in view of pain lasting fr 2 hrs with involvong lad or diagonal territory Or do cor angio

These all 4 ecg's are of 30 min intervals only and patieny is asymptomatic now. Under observation and serial set of markers too are normal.
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It's a case of unstable angina.

2nd ecg from the top suggest IWMI with R.V involment

In second ECG IWMI Third ECG wnl

Could be transient coronary artery spasm .. Echo will help... Repeat trop i after 6 hours..quantitative.. U should also check v7 v8 v9

2nd ecg suggest of acute interior wall mi.further investigation 2d echo should be done

All ecg's are of same patient sir. Taken in 30 min interval with a prior h/o 2 hr chest pain
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There are dynamic changes- st elevation in lead II, st depression in lead I, aVR aVl in the second set of ecgs. Acute coronary syndrome- evoloving mi, is still very likely. Plus the first set of ECG showed hyperacute t waves in the v2 v3. We shd repeat another set of markers to see whether the patient has serial rise.

These all 4 ecg's are of 30 min intervals only and patieny is asymptomatic now. Under observation and serial set of markers too are normal.
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Unstable angina vs nonstemi

Unstable angina, needs angio

AT elevated 2nd 3rd lead with AVF inferior wall MI thrambolised

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