48 yo M. Sudden onset chest pain whilst sleeping. Looks very unwell. Patient was extremely anxious, hypotensive and grey in colour. Previous MI 2 months prior. No other medical history. Chest pain in central and pressure/heavy in nature, radiates to L arm and feels like he's going to die. Whats diagnosis?

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IHD ACS recent Evolved Anterior Wall MI with Inferior Wall Ischemia. Loss of R V1-V5, deep ischemic inverted T waves in precordial leads and inferior leads. Now recurrence of ACS. Needs Admission into CCU. further evaluation Repeat ECG Cardiac Enzymes Echo Coronary Angiogram and revascurisation ie PTCA & Stenting . Before that load with Aspirin Ticagrelor statins heparin nitrates and stabilise anxiety respirationO2 saturation Hemodynamics and sos Morphine, GpIIbIIIa inhibitors IV.

NSR. Axis Normal. Incomplete RBBB. ST depression with convexity in V 3-6. T wave inversion in L 2 3 ,aVF and V 2 - 6. Interpretation : Sub Endocardial Infarction.

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ECG. Sinus Mechanism. ST Elevated in inferior lead with T Inverstion. Q wave are in inferior lead. ST Elevated in Cheast lead with T Inverstion. 1. Extensive Antero- inferiorWall. MI 2. RBBB. With Brugada syndrome. 3.HOCM. Do 2D.ECHO AND cardiac markers

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T wave inversion in lead 2,3 avF, V1 to v6. Non Stemi... Send cardiac enzymes.. Loading dose of ANTIPLATELETS... 2D ECHO.. PREPARE FOR ANGIOGRAPHY ASAP.

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S.Bradycardia RBBB with secondary repolarization changes T wave inversion in inf leads & v3 to v6 Ischemia

Cardiac neurosis if vitals r stable.

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Sinus bradycardia, incomplete RBBB, Right sided of the

NSTEMI ADV CARDIAC ENYMES START ANTIANGINAL &ANTIPLATELETS GO FOR 2D ECHO&CORONARY ANGIO

STEMI

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Wellen's syndrome. RBBB. May convert into STEMI

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