65 yr old female patient suffering from breathlessness and ghabrahat since 2 months.patient is on telma h and ecosprin tab.Kindly give your valuable feedback on ecg and guide on this case



ECG shows LBBB with supraventricular ectopics.Normally a few atrial ectopics do not pose any problem and no treatment is reqd.In cases where the patient has symptoms such as in this one a 24hr holter recording should be done and if multiple frequent atrial ectopics are recorded then amidarone could be given.Other causes such has hyperthyroidism,too much intake of coffee or tea should be excluded.

Wide QRS 0.12 sec QS in v1 Late intrinsicoid deflection

Anterior wall ischaemia with bi lateral bundle branch block with WPW syndrome with ectopics, refer to cardiologist.

first patient should be asked if she has any previous ECG for comparison if same pattern then acute problem is ruled out since history is since 2 months whether symptoms are on exertion or at rest.since ECG is showing LBBB with first degree AV block echocardiogaphy should be done to rule out structural heart disease or lvh trop I or trop T should be done to rule out acute infarct and then treated accordingly

This is a case of anterior wall myocardial infarction..

Atrial ectopic with inverted T in 1 and aVLwirh TV1 >TV6 syndrome with poor progression of R wave in chest leads with left axis deviation. Commonly without disease of the left ventricle atrial ectopics do not precipitate LVF. It means you go for angiography and echocardiography and mange the case with adding diuretic for some days.

I can see anterior wall ischaemia LBBB ectopic poor p waves is she diabetic I think you should treat her as nstemi to be safe and get halter cardiac enzymes and echo done

no history of diabetes

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LAD PAC LBBB Modified SmithSagarboss criteria negative So no acute event Rx as IHD

Lbbb with poor r progression with few atrial ectopics with LAHB 'cardiomyopathy should also be considered

Lbbb...always think abt acute coronary synd..Any cause of severe LVH..hypertension..aortic valve disease etc

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