A male aged 66 years who is a known Diabetic and Hypertensive controlled on treatment p/w complaints of Pain Chest and Sweating since last 5 hrs... comment on his ECG findings and hiw to proceed

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RISK FACTORS FOR CAD 1 AGE 66 2 SEX MALE 3 DM 4 HTN 5 PAIN CHEST 5 HRS 6 SWEATING ECG = SINUS TACHYCARDIA LVH ( VOLTAGE + LEFT ATRIAL STRAIN SEE V2 V3 ) POSSIBLE DIAGNOSIS NSTEMI LVH HTN DM PLAN = BLOOD TROP I ABG SUGAR CREATININE LIPIDS ELECTROLYTES ECG MONITERING RISK STRATIFICATION 1 FALL OF BP / CARDIOGENIC SHOCK 2 ANY LIFETHREATENING ARRHYTHMIA 3 PAIN CHEST STILL CONTINUING 4 HEART FAILURE TREATMENT 1 CONTROL PAIN CHEST SUBLINGUAL NITROGLYCERINE INJ MORPHINE IM SOS O2 INHALATION IF SATURATION < 90 % OR DYSPNOEIC DUEL ANTIPLATELETS + PPI FOR HIGH RISK PTS IMMEDIATE CAG & PCI WITHIN 2 HRS FOR LOW RISK PATIENTS IF TROP I > 99 PERSENTILE OF NORMAL VALUE GO FOR CAG -----> PCI IF PT IS NOT IN PAIN CHEST FOR FEW HRS TROP I IS NEGATIVE GO FOR STRESS ECG IF + VE ---> CAG ---'> PCI IF - VE --- > D D CECT THORAX = DISSECTION OF AORTIC ANEURYSM ? REF TO CARDIOTHORAC SURGEON

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NSR Sinus tachycardia Prominent U waves & distict T wave ? Hypokalaemia Further investigations is necessary

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Sinus TACHYCARDIA. Rule out Hypothyroidism ( low voltage) Investigation: Trop T CPK MB Tab Sorbitrate 5- S/L stat. Tab Met XL50- 1 tab stat. Check CBG ( maybe Hypoglycemia) Check BP. Moist O2 SOS

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S Tachycardia only

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ECG -Sinus tachycardia, LVH by voltage criteria otherwise nonspecific changes.

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Nsr Sinus tachycardia....(complexes narrow)

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Sinus tachycardia

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NSR, Sinus tachycardia Right axis deviation Observation, troponin serial ECGs

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S tachycardia

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NSR AF

Thanx dr Dinesh Gupta
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