Concluded Case

A man with chestpain

55/Male DM HTN Smoker now...chestpain...heaviness..3hours presented in ER PR 110bpm BP 160/90mmHg, SPO2 96% Rest exam normal..no murmurs Hb 10g/dl Creatinine 0.8,mg/dl ECG attached ECHO..LAD territory hypokinetic LVEF 25% No MR/ significant TR/ Effusion Questions? What loading to be given in ER? What is the strategy/ plan? Patient getting discharged at 3rd day of admission, What predischarge investigation to be done?

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Concluded answer

It is STEMI .hyperacute st segment elevation v2 v4.looks like LAD occlusion. Ntg infusion double antiplatelet agents LMWH statins betablockers. Cardiac enzymes. Needs immediate coronary iintervention.If not accessible pl go for thrombolysis

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ECG. ST elevated in Chest lead V1 -V6 woth tombstone like appearance and | and AVL. Reciprocal changes ate in inferior lead. Blockese in proximal LAD. Extensive Anterior Wall Infraction.and pt.is in systolic failure. Urgently subject for diagnostic CAG and required PTCA.

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It is STEMI .hyperacute st segment elevation v2 v4.looks like LAD occlusion. Ntg infusion double antiplatelet agents LMWH statins betablockers. Cardiac enzymes. Needs immediate coronary iintervention.If not accessible pl go for thrombolysis

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Extensive Anteriolateral mi PCI is the 1st choice,,,, If not then Thrombolysis

Early Angiography

Ecopsrin 150 x 2 , Clopidogrel 75 x 4 tab, Atorva 80 mg stat n S/C Clexane 0.6 ml stat if Nt pro BNP is high

Ecosprin is enteric coated tablet..bypasses buccal and gastric absorption...not preferable in ACS. A chewable aspirin (disprin) 325mg is preferable in acute MI.
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HS - Trop-I, Cardiac Marker NT - Pro BNP D- dimer CBC, electro Abg

Just need cardiac monitoring, CBC, KFT, ECG.
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