54-year-old Asian male with syndromic manifestations»

A 54 – year – old Asian male patient, non – smoker, presented with recurrent cold with productive cough, copious expectoration, anosmia, rhinorrhea, headache and progressively increasing exertional shortness of breath for last 7 years . He had been previously treated with antibiotics, antihistamines and bronchodilators , but the response was only partial and temporary . His past history was significant as he had frequent visits to the pediatrician for recurrent respiratory infections . His family history revealed no parental consanguinity . He had been married for the last 28 years, but had no children .

Physical examination :

blood pressure of 120 / 80 mmHg, pulse rate 60 bpm regular . Lungs : Diffuse ronchi and bilateral coarse crackles (more on the left side) were heard . Heart : apical impulse (ictus cordis ) is covered with one digitalis pulp and palped on the right side in fifth intercostal space at the point of intersection with the right midclavicular line . Heart sounds were heard best on the right side of the chest . There was bilateral hippocratic fingers with focal bulbous enlargement of the terminal segments (grade 2 digital clubbing) .

We request : ECG, VCG, Chest X – ray , Ultrasound of the abdomen and genetic screening .

Questions :

1 ) What are the diagnostic keys?

2) Which is the ECG diagnosis?

3) Which is the VCG diagnosis and why ?