Concluded Case

Hypertension with pedal oedema

A 70 years old male - a known hyoertensive on Telmisartan 49 mg + metaprolol 25 mg + chlorthalidone 6.25 mg and hypothyroid on L- thyroxine 25 mcg , and an known case of hyperuricemia gives history of pedal oedema . His whole body profile is normal . A known smoker and history of chronic alcoholism. O/Examination- B.P is normal - no other clinical examination finding except pitting bilateral pedal oedema . Comments on ECG welcomed

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Concluded answer

Left axis deviation Lead 1 positive qrs Lead avf negative indicates that axis is between 0 to -90 . Lead 2 is also negative . So axis is between -30 to -90 . So there is left axis deviation. In left anterior fascicular block.,impulse in LV goes with posterior fascicle, Initially produces r wave in inferior leads II,III,avF. And q wave in left leads aVL,I. Later large R waves in left leads and deep S in inferior leads This takes more time than normal conduction.. so wide qrs seen. R peak time os more in avL And here R in avL meets criteria of LVH.

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Left axis deviation Lead 1 positive qrs Lead avf negative indicates that axis is between 0 to -90 . Lead 2 is also negative . So axis is between -30 to -90 . So there is left axis deviation. In left anterior fascicular block.,impulse in LV goes with posterior fascicle, Initially produces r wave in inferior leads II,III,avF. And q wave in left leads aVL,I. Later large R waves in left leads and deep S in inferior leads This takes more time than normal conduction.. so wide qrs seen. R peak time os more in avL And here R in avL meets criteria of LVH.

ECG is suggestive if left anterior fascicular block Overall clinical picture of Bilateral pedal oedema suggest heart failure Adv 2 D ECHO to look for ejection fraction and diastolic Dysfunction

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Partial lb3 Left Axis deviation Lvh Pitting oedema may show hypertensive heart failure Tab spiromide 20mg. Od

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Ecg reveals Lt axis deviation. T inversion 1 avl .he is a chronic alcoholic. Possibility of Alchoholic liver disease.pl get his Lft usg abdomen pelvis. 2d echo.it is ischemic heart disease with Alchoholic liver disease with hypothyroidism pl put him on.lasilactone 1od.pl hold chlorthalidone. Cardiac failure could be one possibility of oedema feet so also hypoproteinaemia due to liver disease.after the reports u can take final call regarding management

Sinus Tachycardia, LAD, R wave in aVL > 12 mm, ST depression in 1, aVL s/o : LVH with strain Adv: 2 d echo

S.Tachy LAD LAHB LVH with strain Check S.Cr,S Protein level if normal than Echo to ruled out CCF

NSR Sinus tachycardia LAD LAFB, LBBB LVH Suggest ECHO ,BNP ,RFT

Sinus tachycardia Lvh Antwallischemia Electrolyte imbalance

Sinus Tachycardia LAD LAFB