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



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.

sorry, saw this notification just today is the patient stable now? his ecgslows a probable LVH strain pattern and what about history any angina on exertion earlier? or DOE? anything favourable to suggest ACS ? when did the CVA occur? had he been walking? or in prolonged supine posture ? in such a situation PE should also be ruled out apart from ACS with cardiogenic shock and even i cardiac tamponade to be ruled out other causes like LV dysfunction due to sepsis and hypovolemia to be ruled out if clinically relevant .repeat Ecg, echocardiogram and cardiac injury enzymes with CBC would be helpful

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.

It's lvh with strain with re bleed into basal ganglia again same side with mass effect. Thank u all.

Sinus tachycardia lbbb as pt hypotensive with stroke admit DNS 2 decho tropi & t MRI brain

Vora sir, parvez sir ur opnion plz

Patient is having a thalamic bleed, the ecg is showing some non-specific st-t changes, with mildly elevated cardiac enzymes. The hypotension could be secondary to raised ICP, cardiac enzymes are not significantly elevated and can be secondary to non cardiac causes as seen in renal failure and acute pulmonary embolism. Getting a 2d echo and pro bnp will rule out cardiogenic shock. Said that, the differential diagnosis should include anterior wall STEMI. A detailed history along with a thoroug physical exam will norrow down to the most likely diagnosis. Monro-Kellie hypothesis states that the cranial compartment is incompressible, and the volume inside the cranium is a fixed volume. The cranium and its constituents (blood, CSF, and brain tissue) create a state of volume equilibrium, such that any increase in volume of one of the cranial constituents must be compensated by a decrease in volume of another. Checking fundoscopy to look for papilledema, will rule help in knowing raised ICP, although patient is not having the triad of cushing's triad.

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Cardiac enzymes positive

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

Plz elaborate ecg finding? Whether stemi or nstemi?

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

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