45F with C/o breathlessness, productive cough, occasional fever, decreased appetite since 2-3months. Admitted to ED with severe shortness of breath since today morning. Chest b/l scattered crackles+ rhonchi+, Bp 90/60, Pr 120, Spo2 85% RA, 96% with O2. Comment on ECG.. Thankyou..

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Dear Ravi, u have posted very classic ECG.... focus on lead I....it's called as LEAD 1 SIGN/SCHAMROTH SIGN/ISOELECTRIC SIGN... seen in COPD Pat carries poor prognosis due to Pulmonary Hypertension... so all remaining changes in this ECG is attributed to this sign... So check for signs of COPD along with h/o smoking,Choola cooking other occupational hazards... This ECG should not be mistaken for ACS

Lead 1 SIGN. sinus tachycardia. simultaneous t wave inversion in infr and anterior leads present. ..suggestive of PHT. DIAGNOSIS. .COPD .PHT.

COPD CHANGES IN X RAY. .. RT PULMONARY ARTERY ENLARGEMENT rule out miliary tb and pcp. .

S1Q3T3 suggesting Pulmonary embolism? But lead III does not have Q wave. However this classic sign is found in very less number of pt of PE. Please post the ABG and Chest Xray of the patient.

Anterior wall infarction with inferior & lateral wall ischaemia.

S.Tachy T wave inversion in Inf leads, v3 to v5 No dx can be made on the base of ecg Go for x-ray chest. /Echo Check S.Troponin, D diamer

Ecg is showing right axis deviation with T wave inversion in inferolateral leads...NOT CLASSICAL S1Q3T3....but kindly Do ABG..n chest xray.....n ya 2 d echo to look for RA -RV dilatation and pulmonary hypertesion....if all these findings are normal den consider evaluation for ACS...

Her HIV status is positive

As the patient is HIV+ we can give prophylactic Cotrimoxazole for PCP. However the patient is not maintaining saturation its better to give treatment dose of Cotrimoxazol. Steroids should be added. repeat Chest xray must be done after 2-3 days as Miliary TB and PCP patients Xray detoriates very quickly.
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lead 1 sign pht&copd

pl.see for x ray rul out copd ..as spo2 is 85. .With heart failure

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