50yr / male c/o difficult breath - ghabaramn - mild chest pain on and off since 1 year .. kco ht

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Ecg-TWNL. D/D-1-Copd with allergic asthma. 2-acidopeptic disorder. 3-anxity neurosis. Control blood pressure. Do-1-spirometry. 2-xray chest PA view. 3-Upper GI endoscopy. 4-CAG.

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Sinus rhythm, T wave inversion in lead1 and AVL ,v5,v6 with horizontal St segment suggestive of ischemia.low voltage tracing seems electrical alternance. Needed trop T, electrolyts, TFT, lipid profile,cal,mg, CXR PA view, ECHO.

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ECG stable. Adv cxray. Echo CD. PFT. Evaluate and treat for costochondritis or anxiety.

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SINUS TACHYCARDIA L0W VOLTAGE GRAPH MAY HAVE COPD 1FOR SOB + INTERCOSTAL MYALGIA FOR PAIN CHEST

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PL ADD TO MY POST LOW VOLTAGE GRAPH = FITS TO COPD ( EMPHYSEMA ) & NOT TO BRONCHIAL ASTHMA

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Although it is NSR , there are some fluctuations in R wave voltage which may be Electrical Alternans. Please do an Echo.

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Electrical axis is within normal limits

2 degree heart block

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ST sagging in avL & Q wave & QS complex in V1 ? ASMI Trop I & Cardiac enzymes 2D echo

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NSR

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