FOR INFORMATION ONLY: 55yr male, diabetic, presented at OPD with history of pain chest on exertion for last 3 months. ECG : INF. Wall MI ? duration TMT : was not done because of above ECG findings echo: WNL, no RWMA trop-T - negative CAG: coronaries found to be normal. ECG & angio pictures are posted



St elevation smiley pattern seen in lead 1 ..2.3.AVF..V5.V6... Inferolateral leads with pr segment depresssion... Reciprocal st depression and pr segment elevation in AVR... pericarditis more likely...typical chest pain history and pericardial rub gives more clue in this case....

But sir chest pain is on exertion .....still dd will include pericarditis? ???

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We will have to treat it as Unstable angina. We can appreciate tortuosity of the coronaries probably indicative of smoking also.Inferior wall involvement as ecg shows is also because of sluggish blood movement in the coronary i.e.pure cardiac syndrome X. Also there are small q waves developed in lead III,avf and development of RAE +LA some leads like avr,avf more opining towards AV insufficiency So i will go in favour with angio report Cardiac syndrome X with? hypothyroidism having poor progression of r waves and bradycardia with B/L Av valves insufficiency.

LVH with strain Hyperacute T wave in inf leads with reciprocal T wave inversion in lead aVl RCA spasm Prinzmetal angina

Sir if echo is not available immediately then anyone will go for thrombolysis...! Then how to approach such cases???? During medicine practice many times we see slight st elevation in lead 3...

St elevation in lead 1 & 2 as cag & tropt normal it is angina dd GERD

@dr.sanat sahoo ...sir. what about ur expert opinion ?

ST elevation is not convex shaped .. Vasospastic/ prinzmetals angina to be ruled out

This is a case can be considered as ihd unstable angina please treat according to unstable angina line of management

He is a case old inf mi & angio is normal just routine medical management will suffice

If cag normal and no rwma Is there pain b/o ischaemia & how patient improved

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