What can be treatment option for such patient?

Dyspnea and discomfort with dizziness since 2 days. Patient came for routine checkup.. Chief Complaints Dizziness and mild discomfort since 1-2 days. Palpitation and mild dyspnea. Vitals BP: 140/90. P: 144/min feeble. Temperature- normal Physical Examination CVS: irregular, APD of 20. Otherwise normal systemic examination Investigations ECG.. attached. Electrolytes normal range. Echo: EF-45%, No RWMA. Diagnosis Atrial fibrillation Management What is next plan of treatment History Recurrent AF since 5 years.. LVD, HTN.

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Rule out 1 Cardiomyopathy 2.Chronic pulmonary disease 3.IHD 4.Valvular heart disease 5.Strictly control hypertension 6 Electrolyte disturbances Avoid Alcohol, caffeine intake, and stress . Treatment options include 1.Rhythm control medications like procainamide , Disopyramide , amiodarone , sotalol , dofeticide , propafenone 2.Rate controlling medications - Like Digoxin, Metoprolol, verapamil, diltiazem 3.Anticoagulants - like Dabigatran , warfarin 4.Device therapies- Permanent pacemaker Left atrial appendage closure 5.Surgery last resort like Maze procedure

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This is a c/o LBBB/LAD with lt ventricular cardiomyopathy Tracings suggest supraventricular tachycardia Inversion of st in v5v6 Ef 45% poor cardiac output

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ECG shows atrial fibrillation with fast ventricular rate Adv 2 D Echo Control of fast ventricular rate is of paramount importance Adv Beta blocker

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AF with FVR LAD, LAFB, LVH ST depression in lateral chest leads , anterolateral ischemia Needs full cardiac workup. 24 hours Holter monitor. Electrophysiological studies. Thyroid profile. Sinus rhythm can be induced with amiadarone , verapamil. Digoxin is an option if renal functions are normal. Since ECHO does not show valvular diseases, NOAC instead of watfarin will be suitable to prevent thromboembolic phenomena. Since AF is recurrent, NOAC needs to be given continuously , till patient is free fromAF .. Sometimes patient has to take the drug life long. Angio is indicated .Trans Oesophageal ECHO is more reliable to rule out atrial thrombus.

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Put him on beta blocker, warfarin , ARB and mild diuretic. If not controlled and lone AF go for EP and RFA.

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ECG STUDY.. AF .. NEED'S. 2D ECHO STUDY.. CARDIOLOGISTS OPINION.. HOSPITALIZATION IN.. CARDIAC CARE ..CENTERS..

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LAD LAHB IVCD A.fib Lateral wall ischemia

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अर्जुन की छाल को यवकुट करें और फिर 5 ग्राम लेकर एक कप पानी में उबालकर छानकर पी जाएं। सुबह को लहसुन की 4 कली सुबह खाली पेट दें।

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Ventricular Tachycardia MI

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