ECG interpretation

42yr pld female (family complete) a k/c/o rheumatic heart disease with mitral stenosis grade II, tricuspid stenosis grade III, was stable till few days back when she suddenly had palpitations with sweating and mild breathlessness. A similar episode had happened two years back for which cardiac catheterization was performed which was inconclusive. Also has a history of hypothyroidism. Upon examination- BP-90/70mmhg, pulse ~180/min, rr-18/min. One dose of amiodarone was infused after which she was stable. But a similar episode has happened after 36hrs with again pulse going up to 180/min. She is on metoprolol, acitrom, levothyroxin. My question is what should be the next step of management? 1.Should we go for RFA or simply try another dose of amiodarone ? 2. Should we go for valve replacement? Surgeons here (mumbai) suggested for myomectomy+ mechanical valve replacement with tricuspid repair. 3. Is getting valve replacement gonna help with palpitations? Because thats the only concern right now. Thank you (case if of my family memeber: i dont have any other test reports at present)

A male aged 48 years p/w complaints of Heaviness in chest and Dyspnea since 2 hrs... No h/o Sweating or palpitations or collapse...comment on his ECG and discuss the changes...

A 22 year old patient referred for being nervous. She have palpitations occasionally. This was one of her episodes. Diagnose ECG.

A male who is a k/c/o CAD p/w Palpitations and sweating since 1 hour....comment on his ECG Rythm

ca buccal mucosa post local wide excision with tracheostomy done, came to icu for postop care; ecg taken; no hypotension; interpret and what need to be done