Pt h/o hemorrhagic Stroke(thalamus) 3wk back, c/o chest pain with bp 70/shock. Diagnosis and management.



Htn old cva cardiogenic shock ecg incomplete LBBB LVH inotrope cvp guided fluid stablise then PCI

pt. is in acute cardiogenic shock probably due to anterior wall mi (in ECG) to be started on dopamine infusion (if needed start ADR infusion) and then plan for urgent coronary intervention

recent studies have shown that pts. in cardiogenic shock with mi are more benefited with urgent ptca in comparison with pt. who are initially medically stabilised and delayed ptca is done

ECG Left axis deviation with LVH and strain. Thalamic hemorrhage itself can be responsible for this shock and sepsis might be another reason. First send for cardiac enzymes. History of anti hypertensive medication needs to be taken into account. Please correct hypovolumia if any and after correction add inotropes if BP is low. Please monitor urine output. Unlikely to be a case of cardiogenic shock.

V2 v3 shows changes, kindly explain sir.@Dr. Sanjoy Ghosh

to rule out pulmonary embolism.

intracranial bleed can never cause hypovolemic shock because its a closed space and history is not suggestive of sepsis

Oedema of the brain stem can cause vasomotor instability. No ST elevation is seen in any lead so Cardiogenic shock is a remote possibility. Cardiac enzymes elevation in this case can be a clue to subendocardial injury and does not qualify for thrombolysis and thrombolysis is contraindicated in this. Please let us know the results of the investigations.

Cardiac enzymes positive

Positive yes but the quantitative values please.

Cpk 111,troponin 1.7

Plz elaborate ecg finding? Whether stemi or nstemi?

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