A 62 year old lady presents to your OPD with complaints of dizziness and apprehension since 3 months.

 A 62 year old lady presents to your OPD with complaints of dizziness and apprehension since 3 months.

She also occasionally complains of Angina as well.

She denies any fever or other significant problem.

Her BP is 150 / 80 mmHg

There are no other remarkable Respiratory, cardiovascular , GI or neurological system pathology

You note presence of xanthelasmas around her upper eyelids.

1. Which investigations would you like to perform :

2 . What are the findings in ECG

3 . What is the mpost likely diagnosis

4. How will you treat this patient

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1. Which investigations would you like to perform : 

Lipid profile + Cholesterol ,Sugar Levels,ECG,Renal profile 

As patient has high BP and xanthelasmas with a cardiac problem, it would be a good approach to conduct above tests in order to find out the underlying cause of the problem.

2 . What are the findings in ECG 

P-waves have no relation to the QRS complexes. 

The QRS complexes are normal . P-waves have constant PP interval and ride straight through the strip, without any relation to QRS complexes.

3 . What is the most likely diagnosis : 

Third-degree, or complete, heart block.

4. How will you treat this patient : 

The management of complete heart block is dictated by haemodynamic condition and status of patient

As this pt is haemodynamically stable , we will focus on longer term management of the patient.

In case of acute onset and haemodynamically unstable pt, Mx is under taken in CCU and consists of transcutaneous pacing and transvenous pacing and administration of sub cut / iv atropine.

Patient should be administed oxygen.

Ascard 75 mg od should be given with GTN and Clopidrogel 75 mg. 

BP should be controlled . 

Evaluation by a cardiologist is needed and a longer term managemnt plan is required which may inlcude one of below options after evaluation Implantable Device (Pacemaker) Catheter Ablation Internal Cardioversion Implantable Cardioverter Defibrillator Biventricular Pace Maker / CRT