45 yr f atypical chest pain came to er today morning.ddx ecg.n rx pls



ECG IS showing rate induced LBBB T wave inversions in chest leads in narrow beats is because of memory T waves There is no correlation between ACS and rate induced LBBB decision on ASC in this case should be taken on type of Chest pain and trop T positivity

ecg shows intermittent (rate induced) lbbb....pp interval of about 20 sq ie 800 ms is f/b lbbb pattern whereas longer pp interval causes normal qrs....rate induced lbbb may/not be sign of cad....however sinus beats show t inv in i,ii,iii, avf, v1-6 suggesting ischemia....further development of lbbb even at rate of 75/min is s/o cad ...so adv. Stat dose asp vasta cpg sorb, serial ecg and cardiac markers and if need be cag and stenting.

1st, 3rd, 8th beat having normal morphology Remaining beat hv lbbb pattern T wave inversion in inf leads & v1 to v6 in normal beat it may be due to Memory T wave or ischemia Now old ecg is need to rule out rate related LBBB or dual av conduction

sinus beats followed by number of sinus beats with Lt BBB.This may be ACS equivalent. Go for troponin t and other investigation and treat as ACS.Even normal sinus beats without block shows ischemia in v1 to v6.

ECG sx of LBBB, poor progression of R wave n non specific T wave inversion.. However new onset LBBB is related to ACS. Complete physical n cardiac workup including cardiac enzymes n ECHO is required

non progression of r in ant. leads .ant lateral mi

LBBB Send trop T

sinus rhythm with left axis deviation with lvh with lbb. t inversions in anterolateral leads. get trop t and cpk mb levels and rft done. compare with previous ecgs. is it new onset lbb? if new onset, treat with ecosprin av, clopidogrel, nitrates

LAD with LBBB and T wave inversion in 123 avf ,v1to v6.non progression of r waves in ant.leads.Anterolateral MI.Do trop D,2D echo,DM to be ruled out.

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