A 56/M pt present to ED with the c/o moderate uneasiness and heartburn. He had been diagnosed with type 2 diabetes mellitus 4 years earlier. He is suffered from Hypertension, Dyslipidemia, diabetic nephropathy, diabetic retinopathy and peripheral neuropathy. Currently His medications included Telma 40, Ecospirin AV Gold 20 and metformin O/E BP 150/80 mmHg, reduced vibration sense in his feet. ECG is performed, based on ecg findings, Pt denied chest, arm or jaw pain or discomfort; shortness of breath; palpitations; nausea; indigestion or sweating. In view of the ECG changes, What is the most likely diagnosis and treatment

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Anterolateral MI.Take attendant consent. Urgent PTCA if possible otherwise 1.O2 2.Thrombolysed with Streptokinase​ 3.LMWH. 4.Metoprolol 5. Atorvastatin/ Rosuvastatin

Thank you so much for prompt reply
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Looks like evolving lateral wall Stemi involvement of LCX Patient with diabetes and hypertension already has CAD Since chest pain duration is not mentioned.. Patient needs to have loadinv dose ecosprin 325,clopitab300,atorvas 80,pantocid 40mg With clexane 0.6mg stat n then bd Send all cardiac markers

Final Diagnosis is Anterolateral Myocardial Infarction. Thank you so much everyone for making the Diagnosis and line of treatment.

St elevation in V3,4,5, STEMI - Anterolateral mi and t wave inversion in lead lll. Urgent Cardiologist ref for PTCA if possible. Maintain ABCDE and Vitals. ABG with electrolytes, glucose, lactate,hb. Maintain good Oxygenation and urine. Aspirin, clopidograle, atorva, LMWH, Thromolysis if awaiting coronarycath. Need further evaluation Rx.

Treat as acs. Send abg haemogram ck mb trop t. Rfts load with ecosprin clopitab atrvostation. Give inj. Lasix 40 mg stat. Do usg Take openion cardiologest & nephrologest to rule out arf or crf. 2 D echo also helpful. After stable pt. Do cag.

Anteriolateral MI Thrombolyse Urgent cardiology opinion

Lateral wall mi +changes in inf wall to b observed Any way thrombombolise him Follow ur routine protocol Fr further management and intervention

Thank you so much Dr Sanjay Tarlekar.
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ECG is low voltage. HR >100. ST ELEVATED IN inferior lead. And also.ST elevated v4 -V6. QRS Axis is on 60 degrees. Infero- Lat. hyperacute MI. Possibility doublevessels disease i:e. RCA & Left cercumplex block. Adv. Do 2D.Echo. TFT Cardiac markers. And send Pt. For CAG &PTCA

Acute Anterolateral infarction likely inferior wall infarction too. Treat as per ACS.

Thank you Dr Deepak
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Sinus tachycardia,St elevation in v3 to v6.

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