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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Just posted this case to show that in pt with chest pain which seems typical at rest though ECG SHOWEd minor T INVERSIon ECHO NORMAL. Get trop T . If positive treat as unstable angina admit CAG.if negative send home safely get TMT AT FOLLOW UP.dont get TMT IN PT WITH RECENT UNSTABLE ANGINA

Thank you so much for nice case discussion sir
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I shared this case for importance of cardiac enzymes . There were no ST T CHANGES IN SERIAL ECG. Trop t raised 0.02 history of pain typical .so this is unstable angina. Don't do TMT IN UNSTABLE ANGINA PT U CAN GET MI.THIS PT HAD 90 percent lesion to RCA WHICH I STENTED.

T wave inversion in inf leads T wave upright in avl which shouldn't because qrs in avl is negative so T wave also remain negative but here it's not so T wave in avl is indicative of reperfusion T wave flat st t in many leads so inf wall ischemia

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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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

qt interval prolonged, bradycardia n t wave inversion in inferior leads. dynamic ecg study can b done. but considering her age and fresh chest pain, CAG should be done for confirmation.

inferior wall ischemia. cardiac enzymes. (trop T , CPK-MB.)put the pt on Anti anginal drugs. statins etc. Echo can be done to look for any kind of wall motion abnormalities.

avoid TMT
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repeat ecg and troponin T after six hrs. ..now.trt with heparin and antiplatelet.statin. ..CAG later.

Good case. There are some cases in which pt's ecg shows ischemic changes while they are asymptotic and no changes while same pt is symptomatic and in such cases cag showed lad as a culprit vessel. In your case, I recommend CAG if pain is typical.

bradycardia cardiac enzyme lipid profile tsh repeat ECG after two hours keep pt observation echo and plan for tmt or CAG

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