Elderly male presented with sudden episode of syncope followed by Palpitations before coming to ER. His case details are as followed.. Chief Complaints Episode of Syncope followed by Palpitations at farm while working, before arriving to ER. He also had history of anorexia and weight loss since a month. History Chronic smoker. No past comorbidities. Vitals BP 110/70 Heart Rate 180 to 200/min Irregularly irregular pulse Saturation 88% on room air Physical Examination No Pallor, Icterus, Clubbing or Pedal Oedema Respiratory System :- Bilateral basal crackles + Cardiovascular Examination:- Varying intensity of S1 Presence of S3 Investigations ECG :- AF with FVR X RAY CHEST is shown below ESR:- 68 CBC:- WNL Creatinine :- 1.23 RBS :- 121 Electrolytes n Ionized Calcium :- WNL TROPONIN I :- normal NT Pro BNP:- Awaited Diagnosis Please give your differential diagnosis and further approach. Management IV Cordarone 300mg loaded ECG reverted back to Normal Sinus Rhythm Cardiac loading given Oxygen started at beginning only



Cxray shows changes of COPD emphysema, bil mid zonal reticulonoduler opacities with GGos. ? prominent Pulmonary arteries. Dds dissemination of TB, Thromboembolism sec to AF , Neoplastic etiology. Adv MRI brain. If indicated anticoagulation therapy. CSF study. Treatment of COPD including LABA LAMA combination. Anticonvulsant agents, anti arrhythmic drugs. TFT and electrolytes correction.

Ground glass opacity in both lung hilar and mid lung region.. smoker... AF... goes more for chronic bronchitis with possible superadded COVID-19 infection.... Hospitalisation at ICU, treatment for AF and LABA... nebuliser... diuretics if volume overload found on Echocardiography...

Chest Xray shows bilateral haziness with GGO with COPD Emphysema Get HRCT chest for fibrosis or ILD or any malignancy. Sputum culture NCCT brain for any degenerative changes Broad spectrum antibiotics, LABA LAMA

COPD (emphysema with RV type cardiomegaly on xray) with AF with FVR causing pulmonary edema. Sudden development of AF from sinus rhythms had caused syncopal attack.