74 yo male with history of HIV, Hep-C brought in by daughter after days of no appetite and persistent weight loss. Pt denied any symptoms, except for a “slight pain across his upper chest” before he came in. Pt was pain-free upon arrival. ECG obtained,. Troponin 0.108 ng/mL. Other labs within normal limits. Hourly ECG’s were obtained and no changes were noted. Patient remained pain-free during ER stay, and ended up being admitted for pneumonia and further chest pain workup. What is causing this STEMI-like pattern? The slight LBBB?

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Sinus rhythm, regular, 75 bpm, Axis LAD, LAFB, RWP good, ST elevation in V1 to V3, ST depression in L2, L3 and aVF. PVC. Anteroseptal STEMI. Repeat Trop-T, CPK-MB. 2D-ECHOCARDIOGRAPHY.

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LAD STEMI SEPTAL WALL OCCASIONAL VPC cTr after 3 hrs As of is symptom fee he is to observed for further symptoms He is to on STATIN DUEL ANTIPLATELETS ARB METOPROLOL ISOSORBRIDE DINITRATE SUBLINGUAL NITROGLYCERINE TR for HEPATITIS C & HIV. IF NO CHEST PAIN OLD PT WITH SO MANY COMORBITIES HE MAY BE DISCHARGED .SYMPTOM FREE ( PNEUMONIA + PAIN CHEST )

Antero-septal myocardial infartion.
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High risk age group. Not mentioned if trop I or trop T as false positive can occur in pneumonia. R in V3 is is about 2-2.5 mm, J point in v2-3 less than 2mm, LAHB can explain all these. reciprocal depression in inferior leads not expected for v-v3. ST depression in inferior beads. You treat as US/ NSTEMI, ECHO, DELTA TROPONON, CPK MB

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Anteroseptal STEMI , but no LBBB , probably due to HIV, Pneumonia severe inflammatory condition with high fever might have caused coronary spasm leading to STEMI.(lt circumflex coronary artery).

Multi focal VPD if trop T normal ST Elevation may be due to Anureysum.

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Anterior STEMI, With troponin l positive . Echo, CXR, lab test. Cardiologist opinion. Need further evaluation and Rx.

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Atypical pain upper chest ,age 74,Troponin positive &ECG changes in form of ST elevation is significant of IHD. Anterior wall infarction ? Echo.

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That is STEMI only, do a echo Troponin is Positive (>0.02ng/ml)

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Anterior STEMI

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Low voltage in limb leads LAD LAHB Old Anterioseptal mi Check Lytes

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