1. Dr Mirza Javed Iqbal

2. Diagnosis and management of common cardiacproblems which come to this hospital. Identification of common ECG patterns and theirmanagement. Learning ECG interpretation of Common orSerious ECGs. 3. Acute ST Elevation MI (STEMI)Acute Non-ST Elevation MI (N-STEMI)Unstable Angina 4. Attach Cardiac Monitor/Activate Tele + BringCrash Cart Give Oxygen if patient is dyspneic. Take Vitals immediately. IV Line + Samples ECG within 10 minutes of arrival. Analgesia. Nitrate, after seeing blood pressure. Antiplatelets. 5. If STEMI, Immediately consult the PCI hot lineof MCC and verbally inform. If accepted, Thebest transfer target should be < 60 minutesafter arrival. Notify MCC about the time. Keepyour data. 90 Minutes is good. 120 minutes is barely OK.Minute Means Muscle 6. If not accepted or delay is anticipated, or noresponse from higher centre, thrombolysepatients with STEMI within 30 minutes ofarrival, preferably with Reteplase.Continue Other Guideline directed Medicaltherapy (GDMT) of STEMI as directed byACC/AHA or ESC. 7. Hypertensive emergencies are acute,often severe, elevations in blood pressure,accompanied by acute (or rapidlyprogressive) target organ dysfunction, suchas myocardial or cerebral ischemia orinfarction, pulmonary edema, or renalfailure. 8. Hypertensive urgencies are severeelevations in blood pressure withoutsevere symptoms and withoutevidence of acute or progressivetarget organ dysfunction. 9. Hypertensive encephalopathy Grade 4 retinopathy / papilloedema. Intracranial haemorrhage / stroke. Cardiovascular complications. Aortic dissection MI Pulmonary Edema PIH with pre-eclampsia / Eclampsia Acute renal insufficiency. 10. Confirm the diagnosis and assess theseverity.Identify those patients needing specificemergency treatment.Plan long-term treatment. 11. Initial BP reduction of 25% to be achievedover 2-4 hours with a less rapid reductionover 24 hours to a DBP of 100mmHg. Donot go down more than 160 systolic in thefirst 24 hours.Situations where BP must be loweredrapidly are in the context of aorticdissection, MI Eclampsia and ongoingarterial bleed. 12. ECG INTERPRETATION 13. Normal ECG 14. Extra systolesVentricular Extra-systoles / PVCs 15. Extra systoles Ventricular Extrasystoles (PVCs) Junctional extrasystoles. Atrial extrasystoles (APCs) 16. Complete (Third Degree) Heart Block 17. Supraventricular tachycardia (AVNRT) 18. Sinus Tachycardia with anterolateralischemia 19. Atrial Fibrillation and Left Bundle BranchBlock 20. Failure to Capture (PacemakerMalfunction) 21. VVI Pacing 22. Dual Chamber Pacing 23. Acute Anterolateral STEMI 24. WPW syndrome (Type A). 25. Atrial Fibrillation with Fast Ventricular rateDigoxin Effect 26. Dextrocardia 27. Atrial fibrillationLeft Anterior HemiblockAcute Anterolateral STEMI 28. Ventricular Tachycardia 29. Atrial fibrillation with FVRLBBB 30. 2:1 AVB.RBBBLAFB 31. AVRTWPW Syndrome 32. Idio-Ventricular Rhythm / VT 33. Sinus RhythmLBBB PVCs 34. Sinus Node dysfunctionSinus Arrest 35. Atrial FlutterVery slow AV ConductionVentricular Extra-systoles.Prolonged QT interval 36. THANKS