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

All Answers

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.

Lbbb . Do echo mostly he will have severe lv dysfunction. Since nothing acute in symptoms, he might have had silent MI/MIs

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

Lbbb with lvh T inversion in 1 avl v5 v6 qs pattern in anterior leads do cardiac markers & 2d echo rule out hypertensive heart disease

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

Antero lateral MI

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

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.

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

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