Concluded Case

1st degree heart block with ivcd defect with inferolateral ischaemia.

A65yrs old malec/of SOB on exertion. Pt is non diabetic and hypertensive.ecg is enclosed.comment on ecg.diagnosis and management.

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Concluded answer

Bifascicular block i.e LBBB+1st degre heart block

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Bifascicular block i.e LBBB+1st degre heart block

NSR. Axis normal .P mitrale. Inraventricular conduction delay. LVH with systolic overload. Control hypertension. Echo.

Complete RBBB With lateral wall ischemia Borderline LVH Check vitals Start Antihypertensive with consideration to Ramipril with monitoring of urea n creat for remodelling Do start with ecosprin,clopidogrel n atorvas as per

PR interval is prolonged ! ST depression with T inversion in 1,aVL,V4-6 suggestive of anterolateral wall ischaemia! Mangement- CBC, Lipid profile,SCreatinine, S TSH X Ray chest, echo ,TMT and if needed angiography! Ecosprin 75 1 tab daily Atorvastatin 40 mg 1 tab after dinner Beta blocker25 mg 1 tab daily Others as per report!

Severe LVH, conduction delay due to hypertrophied heart, acute ischemia in the myocardium, signs of CHF ? , cardiac markers to rule out angina/unstable angina/NSTEMI. Heart block is making the axis deviation.

1'av block LBBB LVH Advise Echo to ruled out stractural heart dieases

LAFB,LBBB,1* AV BLOCK,LVH WITH STRAIN,LA ABNORMALITY,IVCD

1. Anterolateral MI. LBBB = STEMI 2. LVH with strain. Repeat Ecg in half an hour could r/o active ischemia. And sending for Trop I is needed. Since patient is comfortable at rest, loading dose may/ may not be given.

P mitrale, LVH with strain, 1 degree av block. LVH with systolic overload. IVCD. Echocardiography. Patient may have Mitral stenosis.Dr. M R Chhipa

LBB, LVH with systolic overload. Xray for heart size, stress Echo/stress thallium be done for further evaluation, meantime optimal control of Hypertension

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