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62 yrs smoker male presented with progressive dyspnea and chest pain since last 4 to 5 hrs. his BP 130 / 80mmhg spo2 97% diagnosed as acute coronary syndrome. loading dose of antiplatelets statins with IV nitrates nikorandil LMWH s/ c started. gp2b 3a inhibitors started. ECG repeated after an hour. clinically Patient is improved. my point is , To thrombolysis or to treat as unstable angina , which is correct approach in such cases?

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In first image RR variable with absent p waves s/o AF, ST segment coving with q waves (evolved MI) in avr, v1 with reciprocal st sagging in inferolateral leads. If chest pain persists even after q waves have appeared on ecg you can go for thrombolysis. Thank you sirji.

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Acute inferior wall ischimia Treated very well Successive tracings shows good improvement Pt is diabetic as well as has leucocytosis In my opinion better to to go ahead with angiography and angioplasty rather than unstable angina

Thanx dr Ashok Leel
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In first image RR variable with absent p waves s/o AF, ST segment coving with q waves (evolved MI) in avr, v1 with reciprocal st sagging in inferolateral leads. If chest pain persists even after q waves have appeared on ecg you can go for thrombolysis. Thank you sirji.

CARDIAC enzymes can be the guide. If serial TROPONIN is negative, this presentation can be ACS ,unstable angina. If cardiac enzymes are elevated it can be STEMI or NON STEMI. ECG show AF with FVR , rate related Inferior wall and Antero lateral wall ischemia / OR NONSTEMI in that area . Thrombolysis can be based on troponin levels. Anyway this patient will require urgent ANGIO and STENTING, even though the final ECG is near normal. Diabetes should be controlled with insulin, HYPOKALEMIA should be corrected, renal functions watched .

1st ecg S.Tachy Widespread St depression with St elevation in aVr, v1 Above findings s/o Demand supply mismatch Lf main /TVD /Diffuse Subendocardial ischemia Here trop is not available So we can't give thrombolysis

Rule out Coronarythrombosis with Trponin study. IV Potasium should be taken care of. It seems to be coronary artery disease.

You are on write line of management but case should be followed up by going forPCI after CAG. Coronary thrombosis can be looked for. Regular monitoring and constant evaluation required.

AIWI EECP

Cardiac markers CK MB nd trop t trop I levels helps to distinguish non STMI MI From unstable angina. Better to go wth CM Also adv.NTpro BNP

I AM OF OPINION HE SHOULD GO FOR CAG FOLLOWED BY PCI

Thanks Sir for valuable comments. PCI facilities are available twice in a week as cardiologist visit on that days . So planning it on Friday.
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AV blocks Old inferior block MI Verntricular fibrilation Pericarditis Hyperkalemia

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