40 yr old male experiencing SOB on exertion ,palpitations and occasional burning sensation in mid chest since 7 years. He was taking digoxin 0.25 daily for last 7 years.On examination very thin built ;pulse 110,regular ;BP 100/60 ,no edema. On auscultation s3 gallop was found. Hb 12,TSH -3.5, K+ 3.2 ,Na+ 144. Given djgoxin 0.25 on alt days ,carvedilol 6.25 od ,dytor 5 mg od ,syr potklor 5 ml tds. Adviced for echocardiography. Please suggest any change/ extra advice.



It's a case of Right bundle branch block.

I agree with Dr.S.Sahoo.

Twave inversion in V2345

Significant ST and T changes noted. Large qrs v4-6. ?digoxin induced. RBBB. Right Axis.

Reviours Tike Mark ST segment which shows Digoxine toxicity. ST.are elevated in inferior lead it may be inferior MI.

And complete RBBB

Missing Augmented leads Atrial flutter with 2 : 1 av conduction RBBB Downup T wave in chest leads Check S.Digoxin level Followed by control of rhythm

Do Echo

Inferior wall Mi.. Rbb

RBBB with iferior wall Ischaemia

ECG - atrial tachycardia(210/min) with 2:1 conduction. ST/T changes due to digoxin toxicity precipitated by hypokalemia. ---This is typical case digoxin toxicity -PAT with A-V Block. Other features of ECG are RBBB, RAD, & ? Biventricular enlargement ( large QRS complex v4-v6)

Treatment - Stop digoxin,Supplement Potassium, BB if not contraindicated, monitor.

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