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
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?
intracranial bleed can never cause hypovolemic shock because its a closed space and history is not suggestive of sepsis
Cases that would interest you
- Login to View the image
Dyspnea It is normal with all of us when we exert excessively.. But Dyspnea that is greater than expected with the degree of exertion... is a symptom of disease. Most cases of dyspnea result from asthma, heart failure and myocardial ischemia, chronic obstructive pulmonary disease, interstitial lung disease, pneumonia, or psychogenic disorders.. Below mentioned are the pathological causes of Dyspnea by Organ System…. CARDIO-VASCULAR… Pulmonary edema Acute valvular disease Myocardial infarction Cardiac tamponade Heart failure Angina Constrictive pericarditis RESPIRATORY… Acute exacerbations or persistent chronic asthma Acute exacerbation or persistent chronic obstructive lung disease Pulmonary embolism Pneumothorax Pneumonia ARDS Anaphylaxis COPD Asthma Interstitial lung diseases Pulmonary hypertension Malignancy (tumor related obstructive lesions and lymphangitic spread) Pleural effusions Sleep apnea Foreign body aspiration GASTROINTESTINAL/HEPATIC Acute liver failure and its consequences Abdominal distention of various causes Ascites Portopulmonary hypertension Hepatopulmonary syndrome RENAL CAUSE Acute or chronic renal failure and its consequences HEMATOLOGICAL… Hemorrhage Anemia NEUROMUSCULAR High cervical cord lesions Trauma to phrenic nerves Central apneas Myasthenia gravis Myopathies Amyotrophic lateral sclerosis ENT cause Vocal Cord Dysfunction Laryngeo-tracheal obstruction PSYCHOGENIC BREATHLESSNESS I hope this list of causes will be HELPFUL to diagnose the aetiology of DYSPNEA…
Dr. K N Poddar19 Likes21 Answers - Login to View the image
45 yrs old male pt has admitted with the complaints of giddiness followed by LOC for 20 mnt then recovered. . No h / o chest pain. . breathlessness. . or profuse sweating. . Pt conscious Pulse feeble BP. 90/60 mmhg. . Spo2 ..92 %..room air. 1.. clinical diagnosis? 2 . ECG FINDINGS? 3 . treatment? just now pt admitted. .I'll update further progress. . Plz share your views. .
Dr. Suresh Narayanan6 Likes30 Answers - Login to View the image
50 yrs old male pt admitted with alleged h/o snake bite in his left foot..on admission vitals stable. .CT 20 mnts clotted. .no cellulitis. no ptosis. ECG TAKEN. .. ASV not given. ..antibiotics and iv fluids given. ....then suddenly pt has complaints of chest tightness. .on examination pulse feeble. .BP. 60/?..profuse sweating present. ..what diagnosis. .how to manage this pt in this scenario.
Dr. Suresh Narayanan3 Likes44 Answers - Login to View the image
70 year male. C/o giddiness past 1 hour. No h/o chest pain / fever / cough/ vomiting. H/o outside food intake (in a reception) an hour back. Neither diabetic nor hypertensive. DEAR DOCTORS, NOW Kindly opine on his ECG.
Dr. Mage Kuzhandai Velu0 Like22 Answers - Login to View the image
72 yo male whose symptoms began with a cough 12 hours prior to presentation, at which time he had chest pain, shortness of breath and resp distress. On evaluation, he had pulmonary edema and progressive hypotension. His first ECG
Dr. Manish Malhotra0 Like14 Answers
2 Likes