A 71 yr old male came with dizziness while exercising. Examinations shows systolic murmur & slight left ventricular growth is observed on the chest radiograph.

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I think findings in this ecg are Bradycardia, T wave inverting in L1 avl v5 V6 with down sloping ST segment depicting LVH, segging of ST segment L2, V5 shows three P waves one merges in T wave of its first complex showing Mobitz type 2 block, SV ectopics systolic murmur may be due to MR due to papillary muscle dysfunction. Requires ECHO, Angio.

Thanks sir
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Sir ,The Radiograph not enclosed . ECG T wave inversions Lead 1 avl V5V6 .It will be worth subjecting to CT angiography &Echo . ,This will help in his future treatment and rehab . The murmur may be due to papillary muscle dysfunction.

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LVH WITH STRAI N Lead 1 junctions rhythem0 "" 2 SINUS rhythem Lead 3 from two areas of ATRIUM Ther is a ATRIAL ectopic V2 v3 v3 v4 v5 b6 are punctual bests P waves in twavesv1 v2 v3 v4

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Exercise induced inf wall ischimia t inversion in 1 2 avl and st elevation in v1tov3 and inversion inv5v6 rythm is sinus.

Agree with Dr Agarwal.
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1. Sinus Bradycardia 2. APCs 3. Lateral wall Ischaemia 4. LVH with Strain

Thanks sir
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Exercise induced Lateral wall ischaemia c LV strain

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Thanx dr VedPrakash Sharma

Agree with Dr Agarwal.

Thanks Dr Ved sharma.
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Elderly pt.h/o dizziness on exertion.on auscult- systolic murmur.Cxrshows cardiomegaly. Ecg shows Lvh with strain pattern. &sinus bradycardia. Possibility of calcified aortic stenosis. Confirm by echo - colour dopler study. Go for AVR.

LVH with strain Advise Echo to ruled out stractural heart dieases

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