Concluded Case

Acute Anxiety disorder with ECG?

53 years old female with Hypothyroidism on L- thyroxine 50 mcg - controlled With T2DM- controlled on voglbose 0.2 mg + glimepride 2 mg + met metformin 500 mg O.D With hypertension on Telmisartan 40 mg . C/O acute anxiety disorder which was controlled with clonazepam. Now better - But ECG needs a serious thought Comments on ECG welcomed

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Concluded answer

NSR Left axis deviation. LBBB. If new onset LBBB, needs echo CD and cardiac biomarkers.

All Answers

Lead I shows flat T wave Lead aVL shows T wave inversion Lead V2 - V6 shows T wave inversion All above leads clubbed together represent Anterolateral wall of heart All of them put together suggest ischemia of anterolateral wall of heart - which need to be considered the diagnosis unless proved otherwise Adv 2 D ECHO Cardiac enzymes SOS stress test

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Ecg shows normal sinus rythm Flat T waves and inversion t wave See for cardiac enzyme with other blood routine Electrolyte Sometime this flattened t wave is because of sedative Repeat ecg alternate days

Sir, looks okay, POSSIBLY HYPOTHYROIDISM RELATED T INVERSION LATERAL LEADS, BUT DO A 2DCHO, OTHER HAS DIASTOLIC DYSFUNCTION LIKELY

Sinus rhythm, t Wave inversion in lead AVL , and chest leads with out st segment deviation. Most probably non specific changes .

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Normal sinus rhythm Flat T wave Invert T in lead aVL, V3-v6 R/o any cardiac problem adv cardiac marker and serum electrolytes

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NSR Left axis deviation. LBBB. If new onset LBBB, needs echo CD and cardiac biomarkers.

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Normal sinus rhythm LBBB Needs 2D echo and cardiac enzymes

Thanks@Rajendra Rai
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T wave inversion in v1 to v5 Check S.K level, S.Troponin level If normal than it's nonspecific