55 yrs female c/o vomiting sweating, glidiness sudden onset bp 190/100

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Ecg s/o Atrial fibrillation with fast ventricular rate (approx 140/min) Cause for AF most probably Hypertensive Heart Disease Initially, control the rate with Beta blockers/verapamil/Diltiazem. Digoxin only if the pt is in HF, as their is no mortality benefit using Digoxin. After controlling Rate, repeat Ecg to look for ischemia changes 2D echo to assess for organic heart disease and LA size as well as LA clot. Consider Extra cardiac causes of AF, if cardiac cause is not evident. For Non valvular AF , one should use CHA2DS2VASc score for appropriate anti coagulation therapy. Rate control Vs Rhythm control If chronic AF, with structural heart disease, one should aim for rate Control. Rhythm control only for Paroxysmal AF. CT Brain is MUST in this pt, to rule out Haemorrhagic stroke as the pt is symptomatic and in case of any focal Neurological deficit before starting Antiplatelet or Anticoagulation therapy...and their is always a possibility of Embolic stroke bcoz of AF.

agree with u Dr sandeep Sir. very nice explain

Atrial fibrillation with ST depression on lateral leads. Pt should be shifted to HDC. check cbc Hb1Ac. rbg. Lipid profile. 2 D echo cardio graphy study. Xray to exclude lung involvement. ...

This is a case of atrial fibrillation with right bundle branch block.

LAD SVD R R interval is irregular Narrow QRS

atrial fibrillation

Pt in atrail fibrillation with incomplete RBBB may be due to hypertension control hypertension and af with anti hypertensives and anti arrhythmics respectively

A.fib Inferiolateral ischemia

Atrial fibrillation with st depression in lateral leads...he requires strict ICU monitoring,with a depin stat.,check his cholesterol,trop t, 2d echo, xray chest to r.o pulmonary failure.

Also check her thyroid levels...
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