52 yr female hypertension chest pain associated with sweating lasted for 30 min.no RADIATION OF PAIN . Comes to me in OPD NO ANGINA NOW ECG ATTACHED .comment on Ecg and relevelant investigation.

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Can you get any previous ECG if yes compare both if changes are new treat as unstable angina. If not available and you are convinced that pain is typical of CAD in location, character, radiation, intensity, tempo, associated features then again treat. If still in doubt get an TMT done it will help in deciding treatment.

No changes trop t positive hence CAG directly.
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Low voltage ECG with sinus bradycardia with the wave inversion in 2,3 and avF, prolonged Qt.

sir as you said patient is asymtomatic and serial ECG and echo is normal .she can be put on Ecosprin and statin with sorbitrate sl sos and can be planned for Ct angiography later on.

That's what pt had angina in morning .trop t elevated so needs to be treated as unstable angina. CT ANGIO IS WHEN UR PRETEST PROBALITY OF CAD IS LOW, here it's high hence CAG DIRECTLY.pt will be stable after rest angina . If rest pain continues for 30 min without Ecg changes its non cardiac mostly
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bradycardia long qt and t inv in inf leads episode of typical chest pain and sweating n serial ecgs normal still cag has to be done to r/o cad instead of tmt as this pt has got fresh episode of chest pain with ecg changes also carry out electrolytes and tft

within normal limits

sinus brady with T wave inversion in 2 3 avf lead , adv trop t cpkmb and 2 dcho ,

2 D ECHO NORMAL NO RWMA NORMAL LV FUNCTION . Serial ECG NO change at present pt asymtomatic

Trop t 0.02 ( normal 0.01).

cpkmb ...? treat as non stmi
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yes ECG is relevant

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