Concluded Case

72 year old Hypertensive presenting with dyspnea and fatigue.

72 year old female, complaining of chest pain, fatigue and dyspnea. H/o HTN, DM2, Hyperuricemia on Febuxostat 40 O/E:BP 170/100 Pulse:84bpm Spo2:99% in Room Air ECG attached Please suggest the Probable Diagnosis:

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Ecg shows Lt axis deviation. Incomplete Rbb.t inversion v2v3.pl get her serial ecgs done.pl go for cardiac enzymes. 2d echo.u can give ing lasix 40mg iv.beablocker cardivelol 3.125 mg .tab isosorbide mononitrate 10 mg bd.antiplatelet agents.tab atrovastatin 80.mg stat & later on 40mg Rest of the t/ t to be decided on the lab and echo & serial ecg findings Pl get a cardiologists opinion
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Ecg shows Lt axis deviation. Incomplete Rbb.t inversion v2v3.pl get her serial ecgs done.pl go for cardiac enzymes. 2d echo.u can give ing lasix 40mg iv.beablocker cardivelol 3.125 mg .tab isosorbide mononitrate 10 mg bd.antiplatelet agents.tab atrovastatin 80.mg stat & later on 40mg Rest of the t/ t to be decided on the lab and echo & serial ecg findings Pl get a cardiologists opinion
Thank you sir
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NSR, Sinus tachycardia Left axis deviation, LAHB, Bifascicular block,,RBBB No evidence of ACS . Considering age , co comorbidities, and chest pain, suggest ,observation, troponin, serial ECGs and ECHO
Thank you doctor
0
Thank you so much sir.
HER RISK FACTORS FOR CAD 1 AGE 2 HTN UNCONTROLLED 3 T2 DM 4 HYPERURESEMIA SYMPTOMS SUGGESTIVE OF CAD 1 BPAIN CHEST 2 S O B 3 UNUSEAL FATIGUE ECG LAD LAHB RBBB SEPTAL & LATERAL WALL ISCHAEMIA PROBABLE DIAGNOSIS CAD NSTEMI RECOMMANDATIONS 1 SERIAL ECG 2 BLOOD ABG TROP I PROBNP SUGAR LIPIDS CREATININE 3 CONTROL PAIN CHEST NITROGLYCERINE SUBLINGUAL INJ MORPHINE SOS IM / IV 4 CONTROL BP AVOID BETA BLOCKER AS THERE IS BIFASCICULAR BLOCK IN ECG CCB IF NO HEART FAILURE ARB / ACE I 5 GLYCEMIC CONTROL BY SHORT ACTING INSULIN 6 FEBUXOSTAT IN PRESENCE OF IHD TO BE WITHDRAWN ZYLORIC MAY BE GIVEN INSTEAD 7 CAG 8 PCI IF INDICATED
ECG - Sinus rhythm, LAD, LAFB, incomplete RBBB pattern,st depression in lead V4,5,6, suggestive of ischemia.pt in cp needed further investigation sr ECG, lipid profile, cardiac enzymes, Echo angiography,
Thank you doctor
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Left axis deviation RBBB Left ant hemiblock So, bifasicular block Right ventricular hypertrophy
Missing v4 to v6 LAD LAHB RBBB with secondary repolarization changes
ECG shows... Nsr Bi fascicular block. (LAD LAHB RBBB)
Thank you doctor
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NSR Lt axis deviation Rsr complexes suggest RBBB
Bifascicular block RFT CAG
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