Cardiology board mc qs.ppt2
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The document discusses several different cardiac conditions and test results including atrial fibrillation with complete heart block, second degree 2:1 heart block, complete heart block, atrial flutter with 2:1 block, amyloidosis indicated by an echocardiogram showing severe LVH, speckled appearance and low voltage limb leads on ECG, inferolateral reversible ischemia of moderate degree found on a graft study for a post-CABG patient which also showed an occluded superior OM and diseased OM2 and OM3 that were stented.
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A 60-year-old male with multiple comorbid issues presented to the emergency room with chest pain. An ECG showed tall T waves and right bundle branch block. A CT/PET stress test revealed a small inferolateral infarct and significant peri-infarct ischemia. The patient was referred to cardiology to rule out acute coronary syndrome.
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A 57-year-old male presented with recurrent palpitations. He was diagnosed with rheumatic mitral stenosis, right posterior septal accessory pathway and atrial flutter. An electrophysiological study after percutaneous balloon mitral valvotomy showed that the palpitations were due to atrial flutter with right bundle branch aberrancy. The right posterior septal pathway was a bystander because it had a higher refractory period than the atrioventricular node.
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1. A 40-year-old man presented with cough, swelling of the lower limbs and abdomen, and shortness of breath. Examination found signs of right heart failure and rapid atrial fibrillation.
2. Further history revealed symptoms of hyperthyroidism. Tests confirmed Graves' disease.
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Ventricular fibrillation (VF) is a life-threatening heart rhythm disorder that usually results in cardiac arrest if not treated promptly. It occurs when the lower chambers of the heart beat in an uncoordinated, chaotic fashion, preventing the heart from pumping blood effectively. VF accounts for about 300,000 deaths per year in the United States, making it the leading cause of sudden cardiac death. It is commonly caused by coronary artery disease and often presents as the first sign of a heart attack. Prompt treatment with cardiopulmonary resuscitation and defibrillation can help restore a normal heart rhythm and prevent death from VF in some cases.
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This document discusses heart failure with preserved systolic function, also known as heart failure with normal ejection fraction. Some key points:
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1. A 60-year-old patient with diabetes, hypertension and chest pain, showing an anterior STEMI with inferior ischemia.
2. A 55-year-old woman with shortness of breath and fatigue, showing a low-voltage ECG and echocardiogram revealing pericardial effusion due to severe hypothyroidism.
3. A 60-year-old with chest pain, showing an anteroseptal STEMI with diffuse ischemia.
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The document summarizes the case of a 28 day old neonate admitted to the NICU with respiratory failure and shock. Key details include:
- The infant was born at term and presented on day 10 of life with respiratory distress and poor feeding.
- Examination found differential blood pressures and features of congestive cardiac failure.
- Echocardiogram revealed coarctation of the aorta, which was confirmed as the diagnosis.
- Treatment included PGE1 infusion and the plan is for definitive surgical repair.
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A 41-year-old female presented with breathlessness, palpitations, and chest pain for 3 days. She has a history of valvular heart disease surgery 14 years ago. On examination, she was dyspneic, tachycardic, and had pedal edema. ECG showed atrial fibrillation with a rate of 160 beats/minute. Echocardiogram revealed moderate mitral stenosis and mild tricuspid regurgitation with enlarged left atrium and moderate mitral annular calcification. The patient was diagnosed with atrial fibrillation likely due to rheumatic heart disease.
interesting ECG,CXR,ECHO, FLUORO IMAGE
The document discusses several potential cardiac diagnoses:
1. AV block: 2nd degree Mobitz type I (Wenckebach phenomenon) characterized by progressive PR interval prolongation.
2. ARVD diagnosed based on major/minor echo criteria of RV abnormalities.
3. Brugada syndrome type 1 diagnosed by characteristic ECG pattern with clinical criteria like family history of sudden death.
4. Ashman phenomenon involving aberrant conduction following a short RR interval after a long one due to refractory period differences.
5. Constrictive pericarditis seen on echo as septal bounce in early diastole and increased pericardial echogenicity.
Cardiology presenation 2 im492012 slideshare
This document summarizes presentations from a cardiology conference. It discusses cases of various cardiac conditions including:
1. A 14-year-old male with severe shortness of breath found to have dilated cardiomyopathy, multivalvular lesions, and pericardial effusion.
2. An 86-year-old male with acute heart failure found to have atrial fibrillation, intraventricular conduction delay, and signs of cardiac amyloidosis on clinical examination.
3. A case of Wolff-Parkinson-White syndrome with a short QT interval.
Approach to a patient with QTc interval abnormality in ECG
The QT interval is the time from the start of the Q wave to the end of the T wave.
It represents the time taken for ventricular depolarisation and repolarisation, effectively the period of ventricular systole from ventricular isovolumetric contraction to isovolumetric relaxation.
Case-1: A 23 years old gentleman presented with generalized weakness and fatigue , 2 hours after several bouts of vomiting and diarrhea. His serum potassium was 2.3 mEq/L and he had the following ECG.
Ventricular tachycardia, ventricular flutter, and ventricular fibrillation di...
Differential diagnosis and treatment of ventricular tachycardia, flutter, and ventricular fibrillation
Slide Presentaton/ Quiz Israr bashir
This document contains a series of 15 medical cases presented as images and descriptions. Each case includes radiographic or photographic images, descriptions of patient presentations, and questions about diagnoses and management. Key details provided in the cases include abnormal chest x-ray findings, ECG interpretations, skin lesions, complications of medical procedures and trauma, and congenital anomalies identified on imaging.
Clinical Cases In Cardiology
1) A 24-year-old man was diagnosed with Loeys–Dietz syndrome type 1 based on genetic analysis showing a mutation that puts him at high risk for aortic dissection.
2) A 59-year-old man with a history of carotid stenting presented with visual changes and was found to have retinal cholesterol emboli due to ongoing embolism after stenting.
3) An 83-year-old woman with atrial fibrillation and pacemaker presented with heart failure and was discharged on medical management.
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Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway a...
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preoperative cardaic evaluation for non cardiac surgery
preoperative cardaic evaluation for non cardiac surgery
Approach to a patient with QTc interval abnormality in ECG
Approach to a patient with QTc interval abnormality in ECG
Ventricular tachycardia, ventricular flutter, and ventricular fibrillation di...
Ventricular tachycardia, ventricular flutter, and ventricular fibrillation di...
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This document discusses two case studies in pediatric dentistry and provides a reference. It presents questions related to each case study to prompt further discussion and analysis. The reference cited at the end is a textbook on clinical cases in pediatric dentistry published in 2012.
Core clinical cases in pediatrics
Here are the key concepts needed to work through the growth problems cases:
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Understanding these concepts will help in formulating differential diagnoses, guiding appropriate history taking and examinations, and selecting investigations. Let me know if you need any clarification or have additional questions!
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cardiovascular system-diagnostic tools
This document provides an overview of various diagnostic tools used in cardiology, including electrocardiography (ECG), non-invasive cardiac imaging modalities like echocardiography and nuclear imaging, and invasive diagnostic procedures like cardiac catheterization and coronary angiography. It describes the basic principles, clinical applications, and abnormalities detected by each diagnostic modality.
Ecg in AMI
The document discusses how ECG can be used to diagnose acute myocardial infarction (AMI) and locate the culprit artery. It provides details on:
1) Common ECG patterns seen in AMI including ST elevation, Q waves, T wave changes.
2) How ECG patterns can localize the infarct region and suggest the underlying coronary artery, such as ST elevation in certain leads indicating right coronary or left anterior descending artery.
3) Limitations of ECG including inability to detect all AMIs and accurately estimate infarct size due to individual variations in anatomy and collateral circulation. ECG is not optimal for posterior wall infarcts.
Case 3
This 73-year-old man presented with chest tightness and respiratory distress. He has a history of heart disease including prior heart attack and pacemaker implantation. Electrocardiogram showed paced rhythms, conduction abnormalities, and ST elevation suggestive of heart attack. Imaging showed enlarged heart and pulmonary congestion. Coronary angiography revealed multiple severe blockages. Due to cardiogenic shock, he was placed on devices including IABP and ECMO and started on inotropic medications and dialysis. His condition indicated emergency revascularization was needed.
Mimicks Masks of Myocardial Infarction.pptx
This document discusses various ECG patterns that can mimic myocardial infarction (MI) or mask an underlying MI. It describes patterns seen in conditions like non-infarction ischemia, acute pericarditis, LVH, LBBB, pulmonary embolism, Brugada syndrome, hypothermia, hyperkalemia, and WPW syndrome. It provides the characteristic ECG findings and mechanisms for each of these conditions and discusses how they can simulate or obscure the signs of an acute MI on ECG.
Low Voltage in Limb leads in Arrhythmogenic Cardiomyopathy
Aims: Low voltage in limb leads characterizes left ventricular involvement in arrhythmogenic cardiomyopathy. A large collective of patients with arrhythmogenic cardiomyopathy including 439 patients (268 males, meanage 46.8±11.6 years) were analyzed. Methods: Low voltage in limb leads was analyzed in typical patients with arrhythmogenic cardiomyopathy. Several other electrocardiogram (ECG) features including low voltage in precordial leads, typical appearance in lead a VR, and developing complete right bundle branch block (RBBB) were additionally analyzed. Results: Low voltage in limb leads was found in 61 patients (15%). Three patients represented with low voltage in limb leads and T wave inversions in inferolateral leads characterizing arrhythmogenic left ventricular cardiomyopathy or phospholamban (PLN) cardiomyopathy. In 38 patients low voltage in limb leads and typical ECG findings of arrhythmogenic cardiomyopathy were found. These patients had arrhythmogenic biventricular cardiomyopathy. Low voltage in limb and precordial leads was found in 14 patients with two cardiac deaths due to heart failure. In six cases low voltage in limb and precordial leads and developing complete RBBB were found. Four patients were tranplanted, two cases died due to heart failure. Conclusions: Standard ECG can differentiate between arrhythmogenic left ventricular, arrhythmogenic biventricular, and arrhythmogenic advanced end-stage or PLN-induced cardiomyopathy.
Ekg Cases 7 15 09 Level 2 Part 1
This document discusses strategies for interpreting EKGs in the presence of conduction abnormalities like bundle branch blocks. It provides examples of EKGs showing myocardial infarctions complicating right bundle branch block and left bundle branch block. Key points are that pathologic Q waves can still indicate infarction location, ST elevations are abnormal in bundle branch blocks, and the orientation of ST-T waves can provide clues. Recognition of infarction is still possible despite conduction delays by assessing early versus late QRS deformation.
Repolarization syndromes
Early repolarization (ER), consisting of a J-point elevation, notching or slurring of the terminal portion of the R wave (J wave), and tall/symmetric T wave, is a common finding on the 12-lead electrocardiogram. For decades, it has been considered as benign, barring sporadic case reports and basic electrophysiology research that suggested a critical role of the J wave in the pathogenesis of idiopathic ventricular fibrillation (VF). In 2007-2008, a high prevalence of ER in patients with idiopathic VF was reported and subsequent studies reinforced the results. This PPT describes the current state of knowledge concerning ER syndrome associated with sudden cardiac death.
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This document discusses investigations for a 65-year-old male patient presenting with worsening shortness of breath. On physical examination, the patient was sweating profusely and in respiratory distress. Investigations that may be useful include laboratory tests to rule out heart failure like BNP or NT-proBNP levels, echocardiography to assess cardiac structure and function, chest X-ray to check for pulmonary congestion, electrocardiography to check for abnormalities, and biomarkers to assess prognosis and guide therapy. The document outlines the role and findings of these various diagnostic tests in evaluating the patient's condition and determining if heart failure is present and the underlying etiology.
rare case of cardioembolic stroke in a child
A 10-year-old girl presented with right-sided weakness. Imaging showed large infarcts in both cerebral hemispheres. Echocardiogram revealed left ventricular non-compaction (LVNC), a rare heart condition characterized by excessive trabeculations. This was determined to be the cause of her cardioembolic stroke. LVNC can cause thrombus formation due to slow blood flow in deep recesses, increasing embolic risk even without other structural heart defects. Cardiac MRI is the gold standard for LVNC diagnosis but echocardiogram remains important.
Anaesthetic management of a patient with mitral stenosis put for non-cardiac ...
Mitral stenosis is a narrowing of the mitral valve that causes obstruction of blood flow from the left atrium to the left ventricle. Rheumatic fever is the most common cause. Symptoms range from none in mild cases, to shortness of breath with exertion in moderate cases, to shortness of breath at rest in severe cases. Diagnosis is made through echocardiogram which can assess the severity based on metrics like mitral valve area and pressure gradients. Treatment depends on symptoms and severity, ranging from medications and lifestyle changes in mild cases, to balloon valvuloplasty or surgical commissurotomy in moderate to severe cases. Anesthetic management aims to avoid tachycardia and
Wellens SCH2013-1
This case report describes a 76-year-old female patient who presented with chest pain and was found to have Wellens syndrome, characterized by biphasic or deeply inverted T waves in the precordial leads. Further workup revealed a 95% stenosis in the proximal left anterior descending artery (LAD), which was treated with coronary artery bypass grafting. Wellens syndrome is defined as specific ECG abnormalities associated with a critical LAD stenosis. It often progresses rapidly to anterior wall myocardial infarction if not treated urgently with angiography and revascularization. This case highlights the importance of recognizing the subtle ECG findings of Wellens syndrome to identify high-risk patients and prevent adverse cardiac events.
Mimicks n Masks of MI.pptx
1. The document discusses various ECG patterns that can mimic myocardial infarction (MI), including non-infarction ischemia, pericarditis, LVH, LBBB, pulmonary embolism, Brugada pattern, and hypothermia.
2. It also discusses ECG patterns in MI that can be masked or obscured by other conditions, such as WPW syndrome, LBBB, RBBB, ventricular pacing rhythms, and hypothermia.
3. Criteria are provided to help differentiate MI patterns from mimics in some challenging cases, such as with LBBB, RBBB, ventricular pacing, or hypothermia present.
Early repolarisation syndrome (2)
Early repolarization syndrome is defined by J-point elevation in the ECG. While prevalence is 1-9% depending on factors, the arrhythmic risk is generally low though higher for those with horizontal or downward sloping ST segments. The mechanism involves enhanced outward potassium currents leading to transmural voltage gradients. Genetic variants have been linked to severe cases. Clinical manifestations range from asymptomatic findings to cardiac arrest. Diagnosis requires exclusion of other causes in survivors of sudden cardiac death. Prognosis depends on location and morphology of early repolarization pattern. Therapies include beta-agonists and antiarrhythmic drugs while ICDs are for high-risk patients. Familial inheritance is seen though screening asymptomatic family
Approach to bradyarrythmias1
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Ecg findings in life threatening conditions
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Ischemic heart disease, IHD, ihd, ischemic heart disease ischaemic attack ...
The document discusses the causes, pathophysiology, and types of coronary heart disease (CHD) including stable angina, unstable angina, and myocardial infarction (MI). It covers topics like increased demand on the heart from conditions like hypertension and decreased blood supply from anemia. Diagnostic tests are mentioned like electrocardiograms, cardiac biomarkers, treadmill tests, and imaging exams. Management of acute coronary syndrome (ACS) in the emergency department is also briefly outlined.
ECG: Atrial Dissociation
This ECG shows atrial dissociation in a 70-year-old male with a history of hypertension, coronary artery disease, and cardiac transplantation 6 months prior. Atrial dissociation is seen as two independent sets of P waves with varying PP and PR intervals. Atrial dissociation occurs when each atrium beats separately due to blockage of the Bachmann's bundle interatrial pathway. It can occur in orthotopic and heterotopic heart transplant patients as the posterior atrial wall is retained but denervated after orthotopic transplant.
Case 004
This ECG shows signs of diffuse subendocardial ischemia/infarction in a 62-year-old man with chest tightness and risk factors of diabetes, hypertension, and kidney disease. The ECG findings include left axis deviation, ST segment depression in multiple leads, and ST elevation in leads aVR and V1, suggesting involvement of the left main coronary artery or proximal LAD and LCx arteries. Cardiac enzymes were elevated. Coronary angiography revealed significant stenoses of the left main, LAD, LCx, and RCA arteries consistent with triple vessel disease.
Upper limb ischemia – case presentation
This document presents a case study of an 8-year-old male patient who presented with acute ischemia in his left upper limb. Further examination revealed a large mobile mass in both the patient's left and right atria, which was protruding through the mitral and tricuspid valves. The patient underwent an emergency thrombembolectomy of the left upper limb arteries to treat the acute ischemia. Additional imaging showed an atrial thrombus lodged in a patent foramen ovale. The patient later underwent open heart surgery to remove the thrombus and close the foramen ovale. The surgical treatment was staged with the initial focus on resolving the acute limb ischemia, followed by cardiac intervention to address the source of embolism
INTERESTING ECGS -- PART II
This document contains 16 medical cases involving electrocardiogram (ECG) readings and interpretations. Each case provides an ECG image and description of a patient's symptoms or medical history, and asks the reader to identify the diagnosis or next step. The document also includes explanations of various ECG patterns and conditions, such as R on T phenomenon, hyperkalemia, Brugada syndrome, lead reversals, and long QT interval with T-wave alternans. The goal is to teach readers how to properly analyze ECGs and apply that analysis to diagnosing cardiac conditions.
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Low Voltage in Limb leads in Arrhythmogenic Cardiomyopathy
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#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
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