New admission :- 38 year old female (obese) K/c/o IHD / Hypothyroidism / Post PTCA to LAD (done in 2021 Feb) / RVD + C/o chest pain since last 3 days, dysponea of exertion, giddiness today evening --> Card test trop t positive --> Vitals :- PR 80/min Bp 100/60 on inj NORAD 4 ml/hr RR 25/min SPO2 80% on room air, 94% on 4 lit O2 Ecg T WAVE INVERSION from V2 TO V6 Trop I 7.07, BNP - 323 2D-echo screening suggestive of RA/RV Dilatation, Ef 50-55%, TR +, PAH + TAPSE 1.9 cm Diag :- ACS - NSTEMI, Hypothyroid, obese, post PTCA to LAD, RVD +, ?? Pulmonary embolism PERC +, adv :- CTPA PESI --> 88 intermediate high risk Card ref --> Dr sawant dint advise thrombolysis Adv :- DAPT + Statin + heparin

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