A 65-year old man presents to ED at 1am with 90 minutes of central chest pressure that awoke him from sleep. He says he thinks he has ‘indigestion’. The pain is non-radiating, with mild shortness of breath but no nausea, vomiting or diaphoresis. He is an ex-smoker with a 20 pack-year history. There is no previous history of IHD, diabetes, hypertension or high cholesterol. On arrival he looks well, with normal heart rate (54 bpm), blood pressure (127/86) and oxygen saturations (98% on room air). His pain has improved slightly with sublingual nitrates in the ambulance, although he still has some ongoing chest discomfort. Can you describe the ECG? What is the significance of these ECG findings? How would you manage this patient?

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Left axis deviation of heart Left ventricular hypertrophy I'd like to send for tropT and if further required, will do an echocardiography

LAD WITH LV HYPERTROPHY , PT HAVING UNSTABLE ANGINA WITH IMPANDING MI WITH LVD.

Left axis deviation. But according cheif complaint ,age and life style adv. Cardiac enzymes , Later echo and stress echo.

Stress echo or tmt
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M I . Inf. Wall infraction .need 2 D Echo and and TMT test and blood test like C P k M B if positive go for angiography meanwhile give a dose of low mol. Hiperin .sublingual sorbitrate I.V petaprzol and anti emitics oxygen @inhalation and pain relief drug and bed rest .get the investigation reports and plan treatment.

I don't think TMT. is advisable in this pt.at present if CAD can cause MI.
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Heart rate below 60 is bradycardia

Needs admission under cardiology with serial ECG , cardiac markers , 2DECHO and if any positive needs CAG to rule out ACS .

Repeat ECG,chk cardiac enzymes,and 2DEcho,no TMT when there's pain

U wave inversion in V5,6 and L1. Sign of >75% occlusion of LAD/ LMCA.

Trop I,T. 2D echo. Treat as ACS.
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ECG- mild LVH with Diastolic Streine.Otherwise Basic ECG normal

ORS Axis is on 10 degree considered normal.
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Left axis deviation with left ventricular hypertrophy.

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