58 yrs old female hypertensive 8 yrs duration taking amlodipine 5, hypothyroid of 5 yrs taking 75 microgm, Dyslipidaemia of 5 yrs taking statin.She has no complaints and nondiabetic . ECG on routine shows following. No previous ecg.Now line of treatment?



Dear Deepak, This is a case of 1) HTN 2) Hypothyroidism 3) Dyslipidemia 4) LBBB. Order HbA1c RFT Fasting Lipid profile TFT 2D Echo. Micral. R/O HTN Retinopathy. Per se LBBB doesn't require any medication. But refer to Cardiologist once to have 2D Echo. Continue the remaining Medicine.

Dear, Dr Krishna Mohan, excellent reply. I might have chosen this for accepted answer. Thanks for your reply.

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LBBB with LAHB with PR interval 0.20 sec with right axis suggests ischaemia pathology with LA Enlargement suggests in this case left ventricular hyper trophy. If lbbb is of recent onset it is salient MI otherwise go for trop T. If for longer duration do echocardiography. If the patient have syncope then exclude recurrent CHB. If nothing abnormal control BP with ARB. Control hypothyroidism with Eltroxin according to S TSH. Control lipid by LDL level and exclude fatty liver and keep watch over SGPT. Aspirin must be added . Beta blocker to be avoided.

ecg shows lbb .she must undergo echocardiography and angiography to rule out any coronary blockage as she is having 3 coronary risk factors postmenopausal ,dyslipidemia and hypertension .she can continue same medications but if kft is normal angiotension blocker with small dose of thiazide will be good choice over amlodipine

left axis deviation with QS pattern in v1 to v4, QRS more than 0.12 seconds in v5, slurring with M pattern -LBBB, patient has CAD ridf factors, myocardial perfusion imaging with adenosine may be done as well.

1'AV block LBBB Modified Smith Sagarboss criteria - ve so no acute mi do echo ruled out any stractural abnormality control risk factors

is she well controlled with these medicines of hpt thyroid dysfunction lipid problem?


Left Bundle Branch Block.No treatment required for LBBB unless symptomatic.

lad+lvh+lbbb htn hypothyroidism dislipidaemia pt need ck-MB troponin& bnp echo tmt if pt comfortable or check angio for prevent infarction (coronary or ct angio) last frequent observation for any syncopal attack and monthly review ecg

LBBB. Go for Echocardiography to assess LV function.

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