10/10 substernal chest pain

A 62-year-old female presented with Chest Pain. The patient is pale, diaphoretic, and clutching her chest. The patient reports the sudden onset of 10/10 substernal chest pain radiating to her back approx 1 hour ago along with nausea and vomiting. The patient has a history of MI ten years ago. The patient had syncopal episode prior to the 12-Lead ECG above being obtained. Patient has hx of diabetes and hypertension. IV access obtained and patient received sublingual 3x Nitroglycerin during care with a decrease in pain to 6/10. ABD is not distended or tender and no pulsatile mass is appreciated. The patient also received 8mg Zofran IV for N/V. The patient was transported emergency and treated for the suspected cardiac event (STEMI/NSTEMI Protocol). Vitals: Initial BP 149/98 HR 115 RR 24 Spo2 98 RA CBG 115 Post 3x Nitro at Arrival to ED 120/85 HR 120 RR 17 Spo2 98 RA Please give your suggestions.

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As patient is known case of IHD (old MI) & presented with anginal pain, should be treated as NSTEMI Ix CBC Troponin Lipids Sgpt Creat CXR Echo CAG Rx Aspirin 300mg stat Ticagrelor 180mg/ clopidogrel 300 mg stat Atorvastatin 80 mg Enoxaparin 60 mg S/C bd Metoprolol inj 15 mg over 15 min if bp>100 mod Hg & HR>60 bpm ACE-i NTG drip thr infusion pump Insulin a/c to blood sugar Send for CAG once pt stabilise
Thanx Dr. Ashok Leel sir
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Pt is diabetic and hypertensive Past h/o IHD Presented with typical cardiac pain and event Ecg shows acute repolarisation of t in L2L3 and v2v3v4 Likely anteroseptal ischimia Confirm by cardiac enzymes and trop i She will require CAG as settled down and triple vessel disease probably a candidate for CABG
Thanx dr Dinesh Gupta
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Old case of IHD (MI) Case of NSTEMI Needs further investigation and evaluation to conclude and treatment plan. Till reports complied. Aspirin 300mh stat Clopidogrel 300 mg stat. NGT drip through infusion pump. Atovastin 80mg Regular monitoring and constant evaluation required.
Thanks Dr Dinesh Gupta
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V1 to v4 old antero septal infarction. It is ACS.PL get cardiac enzymes 2d echo.NTg infusion beta blockers double antiplatelet agents. LMWH..depending on the lab reports serial ecgs & 2d echo further line of t/t and as per the advice of attending cardiologist to be followed
SINUS TACHYCARDIA. Non progressive of R wave and inversion of T.
SUGGESTIVE of SINUS. TACHY ADVISABLE ICU. MANAGEMENT
st segment elevation sinus rythm sinus tachycardia
RISK FACTORS FOR HER CAD MI AGE 62 HTN DM PAST MI THIS TIME SEVERE PAIN CHEST RADIATING TO BACK SYNCOPAL ATTACK PRIOR ECG RECORDING THIS TIME ECG = SINUS TACHYCARDIA LAD LAHB POOR R PROGRESSION D = 1 NSTEMI 2 EXCLUDE DISSECTION OF AORTIC ANEURYSM SERIAL ECG BLOOD TROP I CREATININE ABG CECT THORAX IF NOEVIDENCE OF DISSECTION OF AORTIC ANEURYSM CAG PCI
Start S/c LM 0.6 mg 2 times and antiplatele. Iv Dytor 20 mg start plan Xray chest and CAG in ECG old infarction. Medical management keep ìn iccu
LAD LAHB Hyperacute T wave in Inferiolateral leads St depression & T wave inversion in lead aVl Inferiolateral mi
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