Acute Anterioseptal Myocardial ischemia
53/M c/o Severe chest pain (squeezing in nature) radiating to left arm and upper back a/w profuse sweating since 1 hr. k/c/o T2DM x 3 yrs on RX k/c/o smoker - 20 beedi / day x 25 yrs ECG taken Diagnosis and treatment??
There are st-t changes Sagging in L2L3 avf and acute repolarisation with st elevation in v2v3v4 Yes it is Acute anteroseptal myocardial ischimia Adv hospitalization manage with nitroglycerin drip Thrombolisation Monitor with cardiac enzymes Confirm trop i 2decho Adv angiography and sos angioplasty
ECG:ST Elevation in anterior lateral leads Reciprocal ST depression in inferior leads Sinus bradycardia Hyper acute T R/o anterolateralWMI Adv cardiac markers/2d echo/serum electrolytes/serial ECG s
Acute extensive anterior wall STEMI. Immediately give loading dose of Aspirin 325 mg , clopidogrel 300 mg or ticagrelor 180 mg , Atorva statin 80 mg , if hospital capable go for primary PTCA, if not then refer to such hospital within reach of 1 he .. if not thrombolyse better with tenecteplase or reteplase . If not affordable streptokinase. Give assurance, oxygen, sorbitrate, morphine if available, diuretic if Pt is dyspneic and bp permitting, betablocker. Counsel pt attenders ( most important) as these Pts May succumb in a blink of moment
a case of myocardial ischaemia due to complication of uncontrolled/controlled t2dm and chronic smoking.. ecg confirms ischaemia.. advised for troponin tests,chest x ray,serum lipid profile,fbs, ppbs.... treatment is focused on, first, thrombolysis, oral anti coagulant, parenteral opioid analgesics for chest pain.. later, control bd glucose levels with insulin or oral hypoglycaemics.. follow up advise for smoking cessation, and anti diabetic agents and mi opd treatment review for cxr, ecg,fbs,ppbs... to monitor the treatment effects and home based medication..
STEMI ANTERIOR WALL RX RELIEF OF PAIN .. 1 NITROGLYCERINE PO / IV 2 ING MORPHINE IM SOS 3 ANTEPLATELETS CONTROL BLOOD SUGAR BLOOD ABG CREATININE SUGAR TROP I O2 IF SATURATION IS LESS THAN 94 % CAG PCI
It's a case of myocardial ischemia. Check weather trop I is positive. 2 dEcho will be more helpful for further management because chances of blocks are high in this type of cases.
Typical case of Myocardial Ischaemia. Thrombolysis, Pain relief, Hypoglycemic control, smoking cessation, supportive treatment and further evaluation for Cardiac enzymes and Angiography /Echocardiography must be done.
Acute coronary syndrome with ST elevated Anterior wall MI Echo to be done asap Loading dose to be given first Then either Thrombolysis or coronary angiogram to b done. Cardiac markers Cpkmb or trop I will take time to become positive
Stemi with severe bradycardia admit 2decho angiography angioplasty or bypass as per report
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