45 yrs old male pt has admitted with the complaints of giddiness followed by LOC for 20 mnt then recovered. . No h / o chest pain. . breathlessness. . or profuse sweating. . Pt conscious Pulse feeble BP. 90/60 mmhg. . Spo2 ..92 %..room air. 1.. clinical diagnosis? 2 . ECG FINDINGS? 3 . treatment? just now pt admitted. .I'll update further progress. . Plz share your views. .

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I think it's Acute Pulmonary Embolism.. ECG has Sinus Tachycardia with S1Q3T3 and Type C RVH and clinical scenario favours Acute PE. Lysed?

Pt has had LOC for 20 mins. It is not syncope. Pt does not have chest pain or breathless ness. He is having giddiness which is not a feature of pulmonary embolism. The giddiness can be a post ictal phenomenon.
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Clinical impression Syncopcal attack. ECG suggests evolving anteroseptal MI . Cardiac enzymes. Rept ECG. Start treatment as per ACS protocol. Also get RBS to check diabetic status since no chest pain.

Thank you sir
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Thank you so much for all the participants for sharing ur valuable answers. . clinically pt has admitted with the complaints of giddiness followed by LOC for 20 mnt then recovered. . No confusion after recovery. . pt has no tongue bite or frothy dicharge from mouth. .no history of seizures also. . PT has hypotension. . Lungs clear. . Ecg shows. .. Sinus tachycardia S1Q3T3 RBBB. . Suggestive of pulmonary embolism. . Retrospective history showed. .pt had pain in the left calf muscle for past 2 days and tenderness present. . Then echo was done ..immediately. . Echo findings. .. EF .60% RA ..RV DILATED D SIGN PRESENT. . TR + IMPRESSION ... MODERATE PHT CORPULMONALE DUE TO ACUTE PULMONARY EMBOLISM. . THEN PLANNED FOR THROMBOLYSIS. .SINCE PT HAD LOC...CT BRAIN TAKEN. .NO ICH OR INFARCTION. . THROMBOLYSIS DONE WITH INJ. STREPTOKINASE. . USUALLY pulmonary embolism present with Breathlessness Chest pain Hemoptysis .. BUT ...WE MUST KNOW ABOUT THE ATYPICAL PRESENTATION OF PULMONARY EMBOLISM. . SYNCOPE SEIZURES DIMINISHED LEVEL OF CONSCIOUSNESS. ABDOMINAL PAIN .. DELIRIUM IN ELDERLY PTS .. I HAVE POSTED THIS CASE MAINLY TO CREATE AWARENESS ABOUT THE ATYPICAL PRESENTATION OF UNSUSPECTED KILLER. ..PULMONARY EMBOLISM. . I'll share some slides about pulmonary embolism. .. Congratulations Dr. Monika madam for the wonderful answers. .. Again thanks a lot for all ...

thanks sir
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qr in III and avf with st elevation in v2-v4.possibility of inferoanterior ischaemia with cardiogenic shock hypotension and LOC.No chest pain-possibity of silent MI or any angina equivalent. Is the Pt diabetic? next step is echo n cardiac enzymes and if affirmative take him for CAG.

Thank you sir
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CAD /syncopal attack may be due to VT non sustained. Does pt is diabetic? Old inf wall infarction plus anteroseptal infarction recent.S tachycardia rate 120. As per CAD ,monitor in CCU,look for any arrhythmia and treat accordingly.May required PCI if in suitable center.

Thank you sir
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syncopal attack with vbi. ECG s/o old antoseptal wall mi with sinus tachycardia. hospitalisation, o2 inhalation, tab. clopitab -150 od, IV fluids, tab. vertin 8mg bd. keep 6 hrly tpr , bp record. explain the prognosis.

Thank you sir
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She had a syncope..ECG showing ST elevation v234 and S1Q3T3.. send cardiac enzymes..Look for RA Rv dilatation. .If so proceed with CTPA..IF suggestive of pulmonary embolism treatment should include anticoagulation. .

Thank you sir
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poor R wave progression in anterior leads with inferior wall extension-patient is going to cardiogenic shock; ionotropes;BIPAP and sos intubation is required with PPTCA

Thank you sir
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LOC,B.p90/60, pulse feeble S/O cardiogenic shock, hypovolemic shock. ECg show st elevation in v1 v4 sinus tachycardia. s/o ACS AWMI. cardiac biomarkers, thrombolyse.

Thank you madam
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Take MRi r/o malignancy & carotid dopler. Ecg shown old inf wall mi with ST elevation in ant leads.. Need followup ecg with cardiac markers

Thank you sir
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