Case History : A 65 year old lady comes to your OPD in ED with complaints of pain epigastrium and apprehension

A 65 year old lady comes to your OPD in ED with complaints of pain epigastrium and apprehension since 4 hours. Her BP is 170/100 mmHg. You perform an ECG and the result is attached below.

 

You check her oxygen saturation which is 90 %.

1. What are the findings in ECG.

2. What emergency treatment would you give?

3. What is the most likely diagnosis?

4. What other investigations would you like to perform?

5. How will you manage this patient further?

 

Answers given in comments section.

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1. What are ECG findings : 

ST elevation in chest leads with T wave inversions and broad QRS complexes.

 2. What emergency treatment should be given to patient?

1. Analgesic ( opioid eg Inj Tramal intramuscular)

2. High flow oxygen

3. Aspirin and Clopidrogel.

4. Glyceryl Tri nitrate eg Cardnit or sustac 2.6 mg

5. Lower blood pressure with sub lingual Capoten 25 mg stat.

3. Most likely Diagnosis ? 

Acute coronary syndrome / Acute myocardial infarction.

4. What other investigations would you like to perform?

Troponin T and Troponin I levels.

Cardiac enzymes like CK MB, LDH

Chest X-ray and echocardiogram to ascertain Cardiac Failure status

Urea, cholesterol and blood sugar levels.

5. Further management : 

After giving above emergency treatment, refer the patient to a Cardiac Care unit / CCU in a nearby tertiary health care facility for further management.