44 yr old male came to hospital with abdominal discomfort and sweating . No previous history of HTN ,DM ,DLP. Family history of CAD AND HTN. On examination BP180/130 PR 44bpm GRBS 110 mg chest clear s1 s2 heard systolic murmur present over Mitral area. What's ur opinion on ECG and line of management

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There are fluctuating ST T Changed in v3 v 5.if u r sure that there is no acute abdominal pathology then treat as unstable angina. If pt is at low risk of bleeding then give LMWH also. Get enzyme repeat tommarrow. Is Echo feasible in night?

No sir.. Tomo only.. I haven't learnt to do basic echo.. Interested but no one to teach..
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1)ECG NSR ,left axis, APB WITH Pause, marked LVH With strain in V5 V6.IN LEAD V3 biphasic T LOOKS very suspicious for ACS.2) control BP WITH NTG DRIP AND START 2 oral agent ARB AND CCB TO OVERLAP. 3)if no surgical abdomen give antiplatelet.4) get trop T IF POSITIVE START LMWH. 5) ECHO FOR REGIONAL WALL IN LAD TERRITORY AND SEVERITY AND ETIOLOGY OF MR.6)if enzyme positive or Echo RWMA PRESENT THEN EARLY CAG.7) ONCE ACS RULE OUT BY TROP T CAN FOCUS ON OTHER CAUSE OF ABDOMINAL PAIN.8) once acute emergancy ruled out then can get other work up like FBS PLBS RFT USG KUB RENAL ARTERY DOPPLER LIPIDS URINE

Can it be ROEMHELD SYNDROME ???
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can't see ECG properly. but no ST elevation. can start with NTG & anti platelets. but do echo & USG abdomen . look for abdominal aortic aneurysm, pancreatitis. Mitral regurgitation is a possibility( systolic murmur in mitral area)

44 YEARS MALE WITH ABDOMINAL DISCOMFORT SWEATING NO HI DM HYPERTENSION D LP BP ,180/130 MMHG SYSTOLIC MURMUR OVER MITRAL AREA IMPENDING HEART FAILURE. URGENT CARDIOLOGY CONSULTATION E C G TROP T ECHO

Ecg: NSR with LVH by voltage. there is IVCD in inferior lead with negative P wave in lead 3 may need to look for ASD on 2 D Echo. No Q in lateral chest leads so systolic murmer may not be MR or MR may not be severe.. biphasic T waves with positive R in V2 , V3 we need to rule out wellens syndrome as a possibility in which Trop T may not help much but CAG shows lesion. so get Trop T and 2 D echo to get answer for RWMA and Systolic murmer. start on antihypertensive s and evaluate cause of abdominal discomfort by ultrasound...

Thank u sir
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sinus bradycardia biphasic the waves in v2 v3 t inversion in v4; high voltage in v4 v5 with systolic murmur s/o aortic stenosis with LVH strain and biphasic t waves indicate early? ?NSTEMI

LVH with strain St elevation with Biphasic T wave in v2, v3 Anterioseptal mi proximal lad occlusion

1 St LAD TERRIOTY ACS Needs to be rule out by trop t and Echo

Old anterior infarction with LVH, advised cardiac profile.

What's ECHO FINDING USG REPORT AND REPEAT enzyme in yesterday pt

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