70-year old patient presenting to ED with severe chest pain, diaphoresis and syncope. BP 65/40., describe the ecg and diagnosis

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Widespread ST depression affecting multiple precordial (V2-6) and limb leads (esp. I, II, avF). To some extent this is masked by an indistinct J point, upsloping (rather than horizontal) ST depression and some baseline wander of the ECG. There is~3 mm ST elevation in aVR Diagnosis In the context of ischaemic chest pain and cardiogenic shock, the combination of Widespread ST depression ST elevation in aVR > 1 mm ST elevation in aVR > V1 is extremely concerning for left main coronary artery occlusion. However, this pattern is not entirely specific for LMCA occlusion. It may be seen whenever there is diffuse severe subendocardial ischaemia, e.g. Severe triple vessel disease Severe anaemia or hypoxaemia Following resuscitation from cardiac arrest This patient developed progressive cardiogenic shock complicated by runs of ventricular tachycardia. He was taken for immediate angiography where he was found to have a complete ostial occlusion of his left main coronary artery. Pitfalls A similar ECG pattern of diffuse ST depression with ST elevation in aVR may also be seen with supraventricular tachycardias (AVNRT / atrial flutter). This rate-related change is usually benign and resolves with resolution of the SVT.

Ecg is showing sinus tachycardia supra ventricular ectopic present there is diffuse ST depression in inferiolateral leads there is ST elevation in AVR and some ST elevation in V1 possibilities LMCA occlusion Ostial LAD disease TVD In view of marked ST elevation in AVR which is greater than V1 strong possibility of LMCA DISEASE needs urgent CAG a and revascularization accordingly

AvR involvement suggest left main stem disease which is not negotiable with PCI. So CABG is the only option.
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SINUS TACHYCARDIA LAD LAFB. IVCD ST DEPRESSION IN INFERIOR AND ANTEROLATERAL LEADS. ST ELEVATION IN AVR MORE THAN V1. APC. LMCA OCCLUSION OR TRIPLE VESSEL DISEASE. . CAG. .AND CABG NEEDED. .. FOR CARDIOGENIC SHOCK. .IABP MAY B USEFUL. ..

Rhythm is sinus. Each P wave followed by QRS. occasional junctional ectopics. LBBB with reciprocal T wave changes. Probably new onset. MI needs to be ruled out. Need trop I. Urgent angio as patient is hemodynamically unstable. Also urgent K levels as it can mimic same pattern. Till then aspirin, clopidogrel, statin, inotropes. No nitrates and beta blocker till BP above 110.

LAD LAHB Poor progression of r wave across the chest leads Widespread st depression with DeWinter's T wave in v2, v3, 2, avf St elevation in avr, v1 at first look as if lf main or three vessel dieases but 2NDLY THINK ABOUT S.K

Anteriolateral infarction with bilateral bundle branch block.

sinus tachycardia ..supra ventricular tachycardia with ectopic. ....

SVT, ,ADMIT IN ICU, ,CARDIAC MARKERS, ,CBC, ,S ELECTROLYTE, ,LFT, ,RFT, ,FPBS, ,X-RAY CHEST FRONTAL, ,TB ASPIRIN 300 STAT, ,CLOPIDOGREL 300 STAT, ,IV PAN -40 STAT, ,SYP MUCAINE GEL 2TSP STAT, ,,,inotropes, ,TPR/BP /IO CHART, ,SPO2 CHECK, ,S. ABG, ,

This is a case of supra ventricular tachycardia...

ECG is showing pattern of Acute coronary insufficiency with ST elevation in avr suggestive of left main disease pt will require antiplatlet ,lmwh,iontrops,urgent revascularization with IABP support

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