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ECG: Digitalis Effect / MAT / AF
ECG: Digitalis Effect / MAT / AF
ECG: Digitalis Effect / MAT / AF
ECG: Digitalis Effect / MAT / AF
ECG: Digitalis Effect / MAT / AF
ECG: Digitalis Effect / MAT / AF
ECG: Digitalis Effect / MAT / AF
ECG: Digitalis Effect / MAT / AF
ECG: Digitalis Effect / MAT / AF
ECG: Digitalis Effect / MAT / AF
ECG: Digitalis Effect / MAT / AF
ECG: Digitalis Effect / MAT / AF
ECG: Digitalis Effect / MAT / AF
ECG: Digitalis Effect / MAT / AF
ECG: Digitalis Effect / MAT / AF
ECG: Digitalis Effect / MAT / AF
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ECG: Digitalis Effect / MAT / AF

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  • 1. PROF.DR.P.VIJAYARAGHAVAN’S UNIT DR.V.MANIKANDAN
  • 2.  A 41 YEAR OLD FEMALE CAME WITH C/O  BREATHLESSNESS  PALPITATION FOR A DURATION OF 3 DAYS PATIENT WAS APPARENTLY NORMAL 3 DAYS BACK,STARTED DEVELOPING BREATHLESSNESS INITIALLY ON EXERTION NOW AT REST.H/O OF ORTHOPNEA PRESENT.H/O CHEST PAIN PRESENT. PAST H/O:H/O OF SURGERY DONE FOR VALVULAR HEART DISEASE 14 YEARS BACK. PATIENT HAS NOT BEEN TAKING MEDICATIONS FOR PAST 1 WEEEK.
  • 3.  CONSCIOUS,ORIENTED  DYSPNEIC,TACHYPNEIC  PEDAL EDEMA(+)  NO PALLOR,CYANOSIS,CLUBBING  VITALS:  PULSE:140/MT,IRREGULARLY IRREGULAR,VARIABLE VOLUME  B.P:110/70  JVP-ELEVATED  CVS:S1,S2 HEARD,S1 LOUD,MDM(+)  R.S:NVBS HEARD,B/L BASAL CREPTS PRESENT  P/A -SOFT
  • 4. REPEAT ECG
  • 5.  A 12 LEAD ECG WITH,  RATE-160/minute, irregular  Varying RR interval  Axis 90 to 120  Definite discrete p waves not seen.  RVH with ST-T changes.  Rpt. ECG shows fibrillatory waves.
  • 6. Possibilities:  Digitalis effect  Multifocal Atrial Tachycardia  Atrial Fibrillation
  • 7. ECHO FINDINGS:  MODERATE MS,MILD TR  LA DILATED,NO PHT  MVA-1.3 SQ.CM
  • 8.  Low amplitude baseline oscillations and an irregularly irregular ventricular rhythm.  The f waves have a rate of 300 to 600 beats /min.  Variable in shape,amplitude and timing.  Distingushing feature from flutter is absence of uniform and regular atrial activity in other laeds of ecg  chaotic atrial depolarization  the atria contract irregularly and very rapidly producing variable R-R intervals  no regular p waves are identifiable and the baseline is undulating
  • 9.  RHEUMATIC HEART DISEASE,  HYPERTENSION,  ISCHEMIC HEART DISEASE,  PERICARDITIS,  THYROTOXICOSIS,  ALCOHOL INTOXICATION,  MITRAL VALVE PROLAPSE, AND  DIGITALIS TOXICITY
  • 10.  Cardiac arrythmia  Wandering atrial pacemaker  The electrical impulse is generated at a different focus within the atria of the heart each time.
  • 11.  Decompensated chronic lung disease  Congestive heart failure  Digitalis toxicity  Hypokalemia  Methylxanthine toxicity MANAGEMENT: 1. TREATMENT OF UNDERLYING CAUSE 2. ANTIARRYTHMICS OFTEN INEFFECTIVE 3. VERAPAMIL OR AMIODARONE HAVE BEEN USEFUL 4. POTTASIUM AND MAGNESIUM REPLACEMNT EFFECTIVE. 5. ABLATION USEFUL IN SOME CASES.
  • 12. •ECG CHARACTERISTICS: •DISCRETE P WAVES WITH AT LEAST 3 DIFFERENT MORPHOLOGIES • ABSENCE OF ONE DOMINANT ATRIAL PACEMAKER • ATRIAL RATE BETWEEN 100 AND 130. • THE PP, PR, AND RR INTERVALS ALL VARY.
  • 13. •LEFT ATRIAL ENLARGEMENT •RIGHT QRS AXIS DEVIATION •A WIDE FRONTAL PLANE QRS-T ANGLE •ATRIAL FIBRILLATION •A PRECORDIAL MORPHOLOGY WHICH MAY MANIFEST ANY ONE OF THE FOLLOWING FEATURES A RELATIVELY NORMAL,NEUTRAL OR UNREMARKABLE PRESENTATION, RIGHT VENTRICULAR SYSTOLIC OVERLOAD RIGHT VENTRICULAR DIASTOLIC OVERLOAD

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