Concluded Case

72 years old female with profound anorexia and nausea since 20 days visited the opd. Managed with ppi's but to no relief. Urine output is good. No any physical signs. Patient is a known case of bronchial asthma, well controlled on inhaled steroids and salbutamol. Vitals are WNL. Please interpret the EKG.

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Concluded answer
In RBBB, activation of the right ventricle is delayed as depolarisation has to spread across the septum from the left ventricle.The left ventricle is activated normally, meaning that the early part of the QRS complex is unchanged.The delayed right ventricular activation produces a secondary R wave (R) in the right precordial leads (V1-3) and a wide, slurred S wave in the lateral leads.Delayed activation of the right ventricle also gives rise to secondary repolarization abnormalities, with ST depression and T wave inversion in the right precordial leads.In isolated RBBB the cardiac axis is unchanged, as left ventricular activation proceeds normally via the left bundle branch. Causes of RBBB Right ventricular hypertrophy / cor pulmonalePulmonary embolusIschaemic heart diseaseRheumatic heart diseaseMyocarditis or cardiomyopathyDegenerative disease of the conduction systemCongenital heart disease (e.g. atrial septal defect)
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In RBBB, activation of the right ventricle is delayed as depolarisation has to spread across the septum from the left ventricle.The left ventricle is activated normally, meaning that the early part of the QRS complex is unchanged.The delayed right ventricular activation produces a secondary R wave (R) in the right precordial leads (V1-3) and a wide, slurred S wave in the lateral leads.Delayed activation of the right ventricle also gives rise to secondary repolarization abnormalities, with ST depression and T wave inversion in the right precordial leads.In isolated RBBB the cardiac axis is unchanged, as left ventricular activation proceeds normally via the left bundle branch. Causes of RBBB Right ventricular hypertrophy / cor pulmonalePulmonary embolusIschaemic heart diseaseRheumatic heart diseaseMyocarditis or cardiomyopathyDegenerative disease of the conduction systemCongenital heart disease (e.g. atrial septal defect)
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Will advise endoscopy. Why E K G. May be I am missing some thing. Rule out early malignancy. Considering the age.
ecg -complete RBBB,take urine analysis and USG , RFT
Get USG Abdomen & Pelvis done & GI Scopy
Ecg alone cannot interpret many things
It is just one tool
ecg shows sinus tachycardia,rbbb,left atrial enlargement..qt prolonged..elderly ppl always rule out occult infection and sepsis..if stable..rule out cardiac disorders by echo..get electrolytes..thyroid functions..
if al dis is normal..rule out depression
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P.mitrale RBBB with secondary repolarization changes in ant chest leads presenting complain has not to do with ecg To evaluate above findings Echo need once
ecg shows RBBB, But this does not explain about patients symptoms, check her electrolytes and CBC
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