A 60 year old male is complaining of breathlessness for last 2 to 3 days. CBC reveals HB of 6.6 and PLT 123000,rest WNL Vitals WNL No cough etc, chest is clear kindly comment on the ecg?



ECG is suggestive of old Antero lateral M.I with Q wave in some leads . Normsl sinus rhythm. Anaemia and old myocardial insult related now early CCF. A hemoglobin of 6.6 needs investigations and breathlessness is mainly due to anaemia and early CCF. At 60 years - causes of anaemia may be many 1.Stool for occult blood is most important and if present get an OGD done as a bleeding gastric or duodenal ulcer of Ca stomach can occur . 2.A colonoscopy to rule out blood loss from large gut also rule out haemorrhoids 3.Get LFT and KFT done to rule out anaemia of chronic disease like CKD , CLD 4.An Ultrasonography abdomen is always a useful adjunct to investigate anaemia as splenomegaly and intra- abdominal pathology can give some clue 5.Urine for Bence Jones proteins as multiple myrleloma is least investigated cause of anaemia 6 Echocardiography and cardiac evaluation Treatment- 1.Blood transfusion 2.IV ferrous carboxy Maltose after 3 days of blood transfusion in 100 ml of N.S 3.De- worming with Albendazole should always,be done for anaemia 4.Treatment of early CCF and standard treatment for old M.I with Ecosprin AV , chlorthalidone 6.25 , Carca 3.75 , Ranazoline 1 gm O.D Thanks

LAHB. NSR, otherwise normal. Anaemia must be reason for breathlessness... Anaemia profile... needed. Give Total IRON dose as IV ... For instant effect 2-3 units of PCV.

How about ferrous carboxymaltose in 100ml NS two doses in a week?

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Agree with Dr. Bharat Pamnani Q waves in lead I, aVL and V5, V6 indicate lateral wall Myocardial infarction in past As I've observes carefully, QRS complexes in lead V1 and V2 There is clear deflection in upstroke of S wave, this is not fitting in to any particular description of QRS complex - such as RBBB or LBBB When such abnormality in QRS complexes occur which is not fitting in any particular description one need to think of scar tissue caused by Myocardial infarction Depending on location of scar tissue of old Myocardial infarction, there will be deviation in QRS complexes Since the scar can be any where, there is no particular description of such deviation So once again this deviation fits in to description of old myocardial infarction of lateral wall of heart This patient need correction of his low Hb and need investigation for cause of low Hb

Thanks sir

Ecg reveals partial LBB t inversion 1 avl.pl go for 2d echo. Pl analyse the cause of anaemia and correct it.anaemia produces cardiac decompensation.both should be tackled simultaneously

Valuable opinion

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Lt axis deviation Tall t wave v3 tov5 St depression in v1 tov3 Myocardial ischemia 2 decho treadmill test

Anaemia thrombocytopenia do malaria antigen ns1 then if normal ref to haematologist

Ecg-TwNL. Breathlessness is due to anaemia. Advise-blood transfusion at least 2 units. Cap dexorange 1od ×1month. Powder proteins with milk.×30days. Serum proteins albumen and globulin.


Absolutely flattened p Broad qrs complexes Rsr patteren This is a c/o rt axis deviation RBBB Anaemia is aggravating factor

Anemia requires blood transfusion

Thanks Dr. Kute Ankush

Q in lead 1 avl v5 v6 old anterolateral mi now symptoms suggestive of heart failure

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