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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History & ECG is not in favour of ACS. To r/o ACS do Troponin levels; Serial ECG s & 2-D Echo.Hosp.for 24hrs for observations.If no e/o CAD search for non CAD causes of chest pain. Even if it's atypical chest pain & without ST-T changes it can be a ACS hence first priority to r/o CAD.

ECG - sinus bradycardia, LAD. Treat as gastritis, APD,pain killer,keep in observation Sr ECG, BSR, Lipid profile, CXR PA view, cardiac enzymes..

S.bradycardia P.mitrale LVH At this point ecg is not conclusiv because may be of NITRO (subtle findings may subside) Advice serial ecg at 20 min interval

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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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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Sinus bradycardia high voltage r in v5 unstable angina adv trop i serial ecg early echo and CAG as patient is elderly and ex smoker

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 .

NSR , sinus bradycardia Poor progression of R in V1 to V3 Suggest observation, serial ECGs, troponin

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

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