50 yrs old a/k/c of T2DM 15 yr, on OHA, hypertensive for the past 2 yrs on treatment, presents with breathlessness on exertion, abdominal distention, Early satiety 10 days H/O PND 1 episode 15 days back no c/o orthopnea no c/o decreased output O/E facial puffiness+ b/l pitting pedal edema+ lt basal crepts+ investigation urine albumin ++ PPBS 256mg urea 38mg% creatinine 1.91mg% opinion regarding further management



Complete lbbb sinus tachycardia

He is a c/o chr dm2t/ht though on rx but uncontrolled urine alb++ gen anasarca with dysponea. Ecg shows features of over load &lbbb .this all goes in favour of chf/crf rather multiorgan failure.so maintain spo2 give optimum doses of diuretics+lanoxin to improve cardiac output control of bsl by oha+insulin with strict monitoring .continue anti ht. Yes bedside investigations and keep monitoring

LBBB. Concurrent st t changes. LVH. DO echo. Looking like symptoms of heart failure with reduced ejection fraction. Echo will confirm it. With diabetes, CAD likely. Hypertensive leading to lvh. Diuretics to reduce preload will help. Beta blockers will also help like carvedilol. Nitrrates for reducing load. Echo needed.

Sinus tachycardia with features of LBBB.

ECG: sinus tachycardia, LAD, LVH with strain

Sinus tachycardia with LVH with LBBB appears to be a case of hypertensive ht disease with L V dysfunction with nephropathy cardiac echo usg kubp are needed Torsemide and nitrates will help

LBBB, LVH, sinus tacchycardia DM2 with nephropathy r/o LVF secondary to ischemia Adv - 2D ECHO, ABG, electrolytes HbA1c, pro BNP, 24hr urinary protein, USG KUB Rx - O2, Diuretics, ACE inhibitors, correct electrolytes and control sugar


Lvh with strain,lbbb

sinus tachy.Lvh rbbb avoid fluid overload.sugar control and give diureticsand adv echo angiography and cbc lft kft cpkmb and trop t

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