Concluded Case

Htn with cardiomyopathy

a 60 yr old lady with known case of htn having c/o shortness of breath, palpitation.various lab reports are wnl except WBC count 11500..cxr suggestive like copd.on examination, pulse 76/min,bp140/78mmhg,chest and cvs wnl,spo2 98%..2d echo done which is wnl. after awakening in the morning,when she takes medicine she feels more difficulty in breathing and it gradually rises in noon and there after with sunset she feels less breathlessness in night in comparison to morning..there is no cold cough and fever..ecg attached.. what would be the management,plz comment

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Concluded answer

There is some descrepancy in your case ECG shows left ventricular hypertrophy by Sokolov Lyon Sokolow-Lyon Criteria: Add the S wave in V1 plus the R wave in V5 or V6. If the sum is greater than 35 mm, LVH is present. In this case S wave in V1 + R wave in V6 = 40 mm There is P pulmonale - Right atrial enlargement produces a peaked P wave (P pulmonale) with amplitude: > 2.5 mm in the inferior leads (II, III and AVF) > 1.5 mm in V1 and V2 In this case tall peaked P wave in lead II III and aVF and V1 is suggestive of P pulmonale This indicates that patient is having right atrial enlargement as well as left ventricular hypertrophy Right atrial enlargement is suggestive of significant pulmonary hypertension With these changes in ECG - there has to be done thing significant on 2 D ECHO, you can repeat 2 D ECHO It appears that this patient is also having symptoms of congestive heart failure - serum B type natriuretic peptide level can be checked to confirm CCF further treatment based on investigation

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There is some descrepancy in your case ECG shows left ventricular hypertrophy by Sokolov Lyon Sokolow-Lyon Criteria: Add the S wave in V1 plus the R wave in V5 or V6. If the sum is greater than 35 mm, LVH is present. In this case S wave in V1 + R wave in V6 = 40 mm There is P pulmonale - Right atrial enlargement produces a peaked P wave (P pulmonale) with amplitude: > 2.5 mm in the inferior leads (II, III and AVF) > 1.5 mm in V1 and V2 In this case tall peaked P wave in lead II III and aVF and V1 is suggestive of P pulmonale This indicates that patient is having right atrial enlargement as well as left ventricular hypertrophy Right atrial enlargement is suggestive of significant pulmonary hypertension With these changes in ECG - there has to be done thing significant on 2 D ECHO, you can repeat 2 D ECHO It appears that this patient is also having symptoms of congestive heart failure - serum B type natriuretic peptide level can be checked to confirm CCF further treatment based on investigation

Lady pt it is more then 28 it is lvh r in v1 s in v4 or v5
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F/60c/o mornings breathlessness. ECG report p pulmonal . RAH k/c/htn . Should continue anti hypertensive medicine . Tablet Deriphylline. Neb. Asthaline add. Tablet multi vitamins. Do 2D cho . Pft RBS. CXR

Can we get a repeat echo done ?? Ecg is s/o lvh and right atrial enlargement. This can be DCMP. Diuretics should be added along with anti hypertensives and a cardio selective beta blocker. Plus a PFT will be very helpful.

Tall t wave in v2 tov4 Lvh do 2 d echo Cbc xray chest lipid profile Serum creatinine Lvf with myocardial ischemia

NSR P Pulmonale LVH St segment sag in L2,3 and avF ,? IW ischemia Suggest Repeat ECHO HRCT PFT

The tracing shows prominent P pulmonale consistent with findings of copd otherwise normal ecg

Hypertension induce cardiomyopathy.advice echo and ruleout ccf

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