43yr / F, known Diabetic for 12yrs, presented with Fever, Chest Discomfort and Severe Respiratory Distress. Admitted an hour ago. On Admission, HR 138, SpO2 on room air 82%, CBG 245mg. Her ECG and CXR enclosed. Please opine about her PD / DD and Management.

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Ecg shows sinus tachycardia with af and sagging of st segment in v5v6 x-raychest showing cardiomegaly with haziness lt lower lobe and blunting of ltcp angle pl effusion causing hypoxia .since pt is diabetic and uncontrolledas cbg is 245mg start with ketoacidosis hydrate and hrct to r/o lt lung pathology.she may be tubercular.

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Ecg,tachycardia, LBBB,poor R wave progression in ant lat leads ,left axis deviation. Cxray slight rotation.cardiomegaly,bil basal congestion,calcified aortic knuckle.enlarged pulm arteries. DDs:- cardiogenic shock,ARDS,PAE Management: diagnostic-(2d echo/CAG.) NIV,diuetics,tight glycemic control,digoxin/rate reduction,antibiotics,bronchodilaters,LMWH.

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ECG shows Sinus tachycardia, LBBB, poor R wave progression , Cxr shows cardiomegaly with b/l lower zone haziness with b/l obliteration of cp angle all suggestive of CCF, B/L PLEF, PULMONARY EDEMA.

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Cardiogenic pulmonary edema Send trop I / BNP

LAD, sinus tachycardia,it seems like St segment elevation in lead 1 and avl and reciprocal St segment dep in inf leads. LBBB . X Ray chest cardiomegaly, bilateral basal haziness.

As above given history Patient in respiratory distress due to CCF ECG LBBB X-ray bilateral effusion On 02 desaturation Bsl high Get done abg first Start bipap ventilation Get done cardiac work up Cpk cpk mb trop t Diuretic Keep negative balance Control bsl with insulin 2d echo

ECG V1 to v3 is recorded at 5mm/mv S.tachycardia LBBB LVH Modified Smith Sagarboss criteria negative so no acute mi X-ray Cardiomegaly Bilateral pleural effusion Pt night be in P.Odema

cardiogenic pulmonary edema ; send trop I , NT Pro BNP

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Cardiomagaly with lower zone congestion Ecg-St elevation in Lead v1--4 Reciprocal St depression in v5&6 Anteroseptal wall mi

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Cardiomegaly copd emphysema with congestion AF with lbbb left axis deviation o2 therapy blood thinner betablocker sos ablation

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