71 yr/ male patient having chest discomfort since morning k/c/o HTN and BA Bp 170/100 p 80/min spo2 98 please interpret ecg and suggest management

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Wellens syndrome is a pattern of deeply inverted or biphasic T waves in V2-3, which is highly specific for a critical stenosis of the left anterior descending artery (LAD) Deeply-inverted or biphasic T waves in V2-3 (may extend to V1-6) Isoelectric or minimally-elevated ST segment (< 1mm) No precordial Q waves Preserved precordial R wave progression Recent history of angina ECG pattern present in pain-free state Normal or slightly elevated serum cardiac markers

Age and hypertension are the risk factors . T wave inversion seen in avl V234 leads . Cardiac enzymes,Echo and relavant biochemical tests to be done . Serial ECG to be done .

ANTERIOR WALL M I BLOOD cTr ,sugar ,creatinine Rx . Relief. of pain NITROGLYCERINE sublingual/ l V ing morphine Antihypertensive Aspirin + PPI CABG PRIMARY pCI

ANT WALL M I LVH WITH STRAIN ( V4 ) a PAIN relief 1 NITROGLYCERINE ...... 2. Ink morphine b CONTROL BP c ASPIRIN + PPI d BLOOD - cTr ,sugar , CREATININE e CAG f ...... PC I

Anterior septal NSTEMI with? LGL syndrome.

wallens syndrome.... lad stenosis... cariac biomarkers levels should be done .

Wellen's syndrome Anteroseptal wall mi

Sinus rhythm. St coving and symmetric t inversions in v1-v3 suggestive of antero septal MI./wellens syndrome-critical LAD lesion.Needs CAG and proceed as he has risk factors too

Unstable angina

Wellens ECG

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