60/F presented with h/o developed difficulty in breathing a/w chest discomfort present while on travel consulted elsewhere and admitted for further management.h/o giddiness + k/c/o T2DM, SHTN, Hypothyroidism on rx o/e conscious, oriented, dyspneic HR: 92/min BP:140/90mmhg. SPO2:94% investigation and CAG done.. Diagnosis and treatment?? is possible trop I elevated with normal coronaries??

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Compensatory Metabolic acidosis. Diabetic dyslipidemia. RWMA with EF 38% Cxray mediastinal widening and Cardiomegaly. Sugg medical management with antiplatelets statins nitrates nikorandil, ranolazine. Adv thallium viability scan Sos EECP. Medical management of metabolic syndrome.

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Presentation - dyspnoea on exertion ABG shows PaO2 / FiO2 ratio 466 That virtually rule out lung pathology Normal angiography rules out ischaemic heart disease Hypertrophic cardiomyopathy with poor functioning of left ventricular muscles Decreased rejection fraction Congestive cardiac failure Adv Valsartan with sacubitril is drug of choice in treatment of congestive cardiac failure

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One should not confuse with metabolic syndrome X. In cardiac syndrome X it's the coronary that is 150micron which is blocked. So the epicardial coronaries are normal. In these patients the ECG changes and Trop T&I positive .

You mean, Microvascular angina sir?
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Trop I elevation can also be Seen in Congestive cardiac failure Left ventricular wall motion abnormalities Pericarditis chest X-ray shows increased cardiothoracic angle ECHO -ejection fraction 38% & HCM RWMA + with pro BNP elevated & Troponin I elevated Treat as CCF followed by cardiology opinion

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HTN, and DM2 Acidosis, going for ketoacidosis Cardiomegaly, LVH,LVF , LV Systolic and diastolic dysfunction with Regional Wall Motion Abnormality . ECG suggestive of ACS . Leucocytosis, suggestive of Urosepsis . Increased troponin, Normal CABG Coronary angiography delineates major blood vessels . It may miss the smaller branches. With DM and HTN this may be the cause of cardiac failure , ISCHEMIC cardiomyopathy This will explain the conflicting findings in this case . In spite of normal ANGIO, this case should be treated as one of Non STEMI .

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Ecg shows q waves,2 D Echo shows old MI,urine rm shows hematuria,with elevated proBNP, provisional diagnosis is Old CAD with HF with rEF with pul edema. Give NTG infusion to clear chest,reduce fluid overload and clear chest.give diuretics, antieschemic

LVF Uncontrolled DM can cause microangiopathy Trop I is elevated in HF TROPONIN is related to myocardium Any sort of insult to myocardium can cause raise troponin Even false positive is common in renal hepatic derangement...even sinus tachycardia and other tachyarrythmias.

@its ACS t inversion in 1 avl v4 to v6.its antero lateral wall ischemia. Pl go for cardiac enzymes 2d echo sequential ecgs. Pl put her on ntg infusion double antiplatelet agents LMWH statins betablockers. She may go into STEMI.Pl be prepared for thrombolysis

Lvh Ecg show t wave inversion in 1 avl lateral wall ischaemia Q wave present 111 avf v2 v3 infero septal infarction Adv echo control diabetes lipids followed by cardiology opinion

Yes possible in syndrome X. Trop T &I Elevated with normal epicardial coronary arteries.

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