Concluded Case

Emergency Medicine,Interventional Cardiology.

57 Yrs M Smoker came with a Chief Complaint of acute chest pain from 2 hours,sudden in onset in morning around 5.30 am,constricting type,non radiating and Heaviness over left side of chest. Palpitation +ve. Sweating +ve. No H/O Dyspnoea,PND, Orthopnoea. Not a K/C/O of HTN,T2DM and CAD. Non Alcoholic. O/E- All vitals were within normal limits. JVP not raised.No Pedal Edema. PR- 76/min Regular,No Special Character. BP- 126/74 mm hg. SpO2 -98% at room air. Investigations- ECG and Cardiac Troponins done. Trop T found to be Negative. Kindly provide D/D along with the line of treatment.

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Concluded answer

Treat him as a STEMI.. As there is ST elevation in I , avl, V1- V4. Left ventricular hypertrophy, poor R wave progression in V1- V6.. Reciprocal St depression in III, aVf Admit in ICCU , give loading dose of Tab. Ecosprin 300mg, tab. Clopitab 300 mg, Tab. Atorvas 80mg , inj. Lomo as per weight 40- 80 mg S/c, Anti anginal like Beta blockers ( metolar or carvedilol dont give if BP < 110/7 and HR <80 , Sorbitrate 2.6mg dont give if BP < 110/79), inj Nikoran infusion if there is ongoing anginal symptoms but oberve for headache ; if so then stop nikoran , Injectable opiods like inj. Fentanyl 25 mg , or inj. Buorenorphin 0.3mg to relieve anginal pain... plan for CAG as early as possible.....

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Treat him as a STEMI.. As there is ST elevation in I , avl, V1- V4. Left ventricular hypertrophy, poor R wave progression in V1- V6.. Reciprocal St depression in III, aVf Admit in ICCU , give loading dose of Tab. Ecosprin 300mg, tab. Clopitab 300 mg, Tab. Atorvas 80mg , inj. Lomo as per weight 40- 80 mg S/c, Anti anginal like Beta blockers ( metolar or carvedilol dont give if BP < 110/7 and HR <80 , Sorbitrate 2.6mg dont give if BP < 110/79), inj Nikoran infusion if there is ongoing anginal symptoms but oberve for headache ; if so then stop nikoran , Injectable opiods like inj. Fentanyl 25 mg , or inj. Buorenorphin 0.3mg to relieve anginal pain... plan for CAG as early as possible.....

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Up to 3 hrs Troponin may come negative,,,, Two option PTCA / thrombolysis ( after risk calculation)

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Go for early PCI.

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St elevation in lead 1, avl,v2--5 STEMI

LVH AWMI

R B B B consult cardiologist

Its not RBBB...
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Its semi but need further investigation repeat ecg RepeT cpkmb Trop i also

Trop T should be repeat after some time.. It's stemi

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