This 64 year old woman presented intoxicated with nausea and vomiting and epigastric pain, with no chest pain. She has a history of a stent, but unknown in which artery. She stopped taking clopidogrel 2 weeks ago because she ran out. Here is the initial ECG; there was no previous ECG for comparison. Comment

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May be persistent juvenile T-wave pattern. LVH by voltage pattern . Cardiac Troponin T / I estimation and PT, INR, APTT. Rule out gastrointestinal emergencies like perforated ulcer, acute pancreatitis and acute cholecystitis. Transient T-wave inversion may occur in the following conditions : - Acute coronary syndrome Cardiac memory T-wave Cardiogenic non-ischemic pulmonary edema Gastroenteritis Post maxillofacial surgery Subarachnoid hemorrhage Electroconvulsive therapy Takotsubo cardiomyopathy Pheochromocytoma and Indeterminate origin Whereas, permanent T-wave inversion may accompany a variety of isorders :- Associated with LV or RV cardiomyopathy such as Apical hypertrophic cardiomyopathy (AHCM)and Arrhythmogenic right ventricular cardiomyopathy/dysplasia .

Sinus rhythm, t wave inversion in Inferior and lead v4 to v6. Pt c/o epigastric pain, vomiting. So treat as acute gastritis and accompany investigation for abdominal as well as cardiac veiw to rule out ischeamia.cbc USG,lft ,kft ,Sr ECG , cardiac enzymes, ECHO.

Ischaemic changes in inferior lateral wall,. O2, ecosprine, clopitab, atorvast, and beta blocker / ace inhibitor as per chest finding and BP,. Do trop t repeat ecg Manage according trop t finding

manage as acid peptic disease . But monitor ECGs ..... if repeated ECGs are same continue treatment for APD .... Meanwhile if pt got relief start clopedegral and statins ... Blood pressure should be normal and see blood sugar level as well ....and manage accordingly

We should strongly suspect acute coronary syndrome,but simultaneously intraabdominal pathology should be ruled out,so we should do clinical examination of abdomen for tenderness,/rigidity then sonogram of abdomen then 2d echo,troponins,amylase sgpt etc will conclude the case,

Inferolateral isch

T wave inversion in inf leads & v4 to v6 As there's no acute C.P check S.K Manage symptomatically Do serial ecg to see to evolve T wave changes

Inferio lateral ischemia with acid peptic disorder. Advised repeat ECG, USG abdomen, cardiac and pancreatic markers. Treat on the lines of acid peptic disorder.

inferolateral mi

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