60 yr old male with h/o old awmi (8 years)with diabetes (20 yrs)

60 yr old male with h/o old awmi (8 years)with diabetes (20 yrs) , on medical management c/o heaviness and breathlessness for brief time period 3-4 times per week, LVEF 30% . Explain the ECG and management please.

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This is a case of ischaemic cardiomyopathy probably in compensated state now having angina & ischemia induced further depression of LV function as evident by significant ischaemic ST/ T changes in v2-v6. Investigations:- trop-T, re assess LV function & RWMA, CAG & myocardial viability ( tc99 sesta MIBI or PET). Diabetic status, & renal function. Management:- 1. If TVD/ MVD with viable myocardium - revascularization- CABG is preferred ( LV dysfunction, DM) 2. Viable myocardium but no good target (diffuse disease) think of revascularization of culprit vessel ( seems to be LAD) by PCI if suitable. 3. If the above options are not possible- then optimal antianginal and antifalure treatment. - Consider ICD - consider EECP ( 1hr/dayx5d/weekx7) total 35 hr course.

Excellent answer and opinion Thanks Dr.sanat sahoo Dr.khan
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Inferoposterior wall MI

Inferoposterior wall STEMI

SR. left axis deviation st depression and r waves in v1-v3 suggestive of RV overliad status Do an angiogram to ruleout the cause of LV dysfunction.

Left axis deviation with anterolateral mi Oxygen inhalation ,vital monitoring Tropi 2d echo Expert cardiology consultation

Late presentation of Inferioposterior mi with RV involvement Cath

Well I am with the opinion of Dr.sanat sahoo. Great answer.and good opinion. Dr.khan

Agree
0

I agree with Dr.S.Sahoo.

ST depression in I , aVL, and V2 to V6 Do right sided ECG. Treat on the lines of ACS as a Posterior lateral wall MI

Inferior posterior

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