45/F presented with c/o left arm numbness since 4 days initially its started from the left fingers with history of left upper back pain associated with sweating, giddiness, palpitation & nausea. no any systemic illness. Fhx : father had CAD @ age of 45 BP:170/100mmg HR:106/min Spo2:97% in RA ECG interpretation & Diagnosis ??

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Sinus rhythm - every QRS complex is preceded by P wave Tachycardia - rate of 100/min Anterior leads V1 - V4 are showing deep pathological Q wave with J point elevation And corresponding T wave inversion in lead I and aVL It is suggestive of acute myocardial infarction 2 D echo, cardiac enzymes and Angiography

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T inversion L1 avl Acute repolarisation v1tov4 Anacrotic notch on R on up limb with broad qtc Bigemini in v5 Sinus tachycardia Hypertensive Family h/o heart disease ?PWP Anteroseptal ischimia

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NSR ,with sinus tachycardia Left Axis Deviation , LAHB, LBBB QS in V1 to V4 . with Hyperacute T waves ? Old Anterior wall MI , Difficult to rule out STEMI in presence of LBBB . Considering the clinical picture and Hyperacute T , Suggest observation, troponin, serial ECGS

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Ecg shows Twave inversion in lead 1st avl and ST flattening and qs pattern in 2 and 3rd limb leads and qs pattern and tall andupright t wave suggestive of acute anteroseptal myocardial infaction -cause -LBBB.do cardiac biomarker test CAGand hospitalization in icu.

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Its a case of sinus tachycardia.Investigations needs to be performed to confirm myocardial infarction.

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Very very challenging...This ECG is a classic example of NEWLY DEVELOPED LBBB with 'Sgarbossa Criteria" negative for MI... This patient will also have moderately elevated cardiac enzymes and leading to false diagnosis of ALWMI...thorough serial ecg monitoring is advised...and of course the HTN and newly diagnosed LBBB should be treated initially by giving "Loading treatment "... but first the HTN should be treated properly...then the ischemic changes should be worried about...do not hurry by putting financial burden on the patient unnecessarily sending costly investigations like cardiac enzymes first...the symptoms are of unstable angina...which will also give rise in cardiac enzymes...all other opinions are awaited and welcomed....

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Hyperacute changes in precordial leads,t wave inversion in lateral leads s/o ihd

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Not enough wide to call LBBB S.Tachy LVH Late presentation of Anterioseptal mi

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Heart Attack because V1,V2,V3,V4 Q T Segment abnormal

SINUS TACHYCARDIA ANTEROSEPTAL WALL STEMI

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