A 32 yrs male,smoker came to me with c/ochest pain retrosternal early in the morning,squeezing,pointing at precordial area near xephisternum intermittent and some times burning and pricking,it is unusal feeling for him. Ecg done twice but cardiologists are confused,Plz discuss

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After chest pain resolves, plz take a ecg. Compare both ecg whether there is any St elevation or not. It's very difficult to know, but as the patient is smoker, chest pain may be due to coronary artery spasm, (? prinzmetal Angina) they are at high risk of developing ami. Dd benign early repolarization syndrome

It is apparently normal ecg except there is a subtle J point elevation in V2 and V3. Serial ecg every 15 minutes for 2 hours would be wise taking his nature, location of pain and smoking history into account. Trop T is to be done 6 hours later. 2D echocardiography is suggested. I have come across ACS patients mostly in early morning hours.

Please consider other DDs like GERD, costochondritis. Is he an alcoholic?
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ECG within normal limits Relief of chest pain with Sorbitrate can happen with GERD also as Sorbitrate relieves oesophageal spasm , It is not conclusive . Suggest admission, observation, serial ECGS, troponin

ecg shows wnl. pain may be due to severe gastritis. pancreatitis. pleurisy which are common in smokers. .

As the ECG appears to be WNL, The next best thing is to do a sorbitrate test. Give 5mg sorbitrate sublingually and watch for the pain. If the patient feels pain relief in 2 to 3 minutes, the likelihood of cardiac pain could be a reality and then the patient should be shifted to CCU for further management. Secondly, if no relief then give him 30 ml of Mucaine Gel and ask for pain relief after 5 to 10minutes, if the pain relief is there then it could be GERD more specifically acute gastritis with reflux. As the patient is a smoker, the possibility of GERD are more. If any effort of exertion enhances the pain then it points towards cardiac involvement. The real treatment will depend upon the outcome of these tests.

yes,It turned out to be benign early repolarization syndrome.patient has been given ppi and muscle relaxant with paracetamol,adv Ecg after pain resolves with 2d echo &Tmt.

Ecg reveals sinus tachycardia. High st segment uptake v1 v3.serial ecgs to be followed through cardiac evaluation cardiac enzymes. Pl treat it as ACS.with ntg infusion double antiplatelet agents LMWH

height of j elevation and t wave is much more in 1st ecg. If symptoms are severe than ACS cannot be ruled out, may consider as posterior mi. Should be considered as ACS unless proved otherwise.

amplitude of the waves in precordial leads is raised as compared to first ecg...trop I serial ecg urgent echo...sos CAG

t waves
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Electrical axis is within normal limits

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