Concluded Case

DM Type 2 ,HTN,IHD

Patient come with gabhrahat, constipation (flatus not pass since yesterday morning), sweating, semiconscious stage Chief Complaints Patient come with gabhrahat, constipation (flatus not pass since yesterday morning), sweating, semiconscious stage Vomiting 5-6 episodes History Patient known case of DM and HTN Post operative Cholecystectomy Vitals BP 80/50 HR 53 Spo2 85% Temp normal Physical Examination Abdomen distended Investigations RBS 305 Rest of attached Diagnosis DM Type 2,LVH with LV dysfunction Management Please give ur valuable comments

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Concluded answer

Ecg changes wide qrs complexes st-t are flattened in limb leads and depression in avl but st is raised in all anterior chest leads suggestive 9f early or impending STEMI/AWMI Consistant with 2decho findings like lv systolic dysfunction and diskinesia of anterior surface lt ventricle in apical area Lt ventricular dilatation likely to PAH Pt is diabetic and having uncontrolled Rbsl simultaneously deranged KFTS as bul and sr creatinine are raised suggestive of DKD Derangement liver enzymes are consistent with cardiac status as PAH Low bp low HDL are indicating h8gh risk cardiac involvement likely pt is in cardiogenic shock as bp is 80/60 and semiconcious Symptoms of constipation and not realising of flattus like a/w cardiac ischimia so as diabetic gasteroparasis So critical and requires to manage multiorgan failure

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Ecg changes wide qrs complexes st-t are flattened in limb leads and depression in avl but st is raised in all anterior chest leads suggestive 9f early or impending STEMI/AWMI Consistant with 2decho findings like lv systolic dysfunction and diskinesia of anterior surface lt ventricle in apical area Lt ventricular dilatation likely to PAH Pt is diabetic and having uncontrolled Rbsl simultaneously deranged KFTS as bul and sr creatinine are raised suggestive of DKD Derangement liver enzymes are consistent with cardiac status as PAH Low bp low HDL are indicating h8gh risk cardiac involvement likely pt is in cardiogenic shock as bp is 80/60 and semiconcious Symptoms of constipation and not realising of flattus like a/w cardiac ischimia so as diabetic gasteroparasis So critical and requires to manage multiorgan failure

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ECG changes are suggestive of STEMI It is substanted by Echocardiography findings of LAD territory hypokonesia,and LVEF 40 % with concentric LVH and left ventricular diastolic dysfunction. The abdominal findings and SAIO can be associated with Acute MI and DM associated GI.T paresis - may be part of septicaemia Get urgent Trop - T test At present the priority is to decide whether patient requires thrombolysis or not It it is done then take care of septicaemia and DM -

AWMI Advise x-ray to ruled out P.ODEMA /Covid 19

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