Chest pain

H/o Diabetes 10 yrs and hypertension 12yrs Chief Complaints Chest heaviness and pain over lt shoulder and arm. History A female pt of 70yrs developed moderately severe chest pain (lt) and heaviness along with pain of left shoulder and arm.Chest pain subsided in couple of hrs after taking aspirin but pain and heaviness of shoulder and arm persisting one day later when ECG is being taken.She is diabetic on multiple ohd, F 175 on glucometer .She is also hypertensive on valsartan40.BP 140/80.Comments on ECG and further line of action which may be appropriate. Vitals Pulse 90,BP 140/80mmHg Physical Examination NAD Diagnosis ? Management ?

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ECG is having Bifascicular block with ST-T of non significant nature. Needs to go for 2DECHO and cardiac markers test. Consider DM as equivalent to MI .. so treat as ACS case till you receive reports...

Please tell sir what will be significant criteria for Bifascicular block in ECG
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Ecg shows bifascicular block with prolonged QTc See for cardiac enzyme See for 2decho See blood report and sr electrolyte Give loading dose And repeat ecg after 2 hours Treat accordingly

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Chest leads r recorded at Half standard Low voltage in chest leads RBBB with secondary repolarization changes Nothing acute in ecg Do S.Troponin

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Do all Relevant investigation, Treat ACS guidelines

Rbbb rt axis deviation lead reversal

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Bifascicular block RBBB + LAFB

Is voltage set on half 5mm?

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