ECG: Dextrocardia
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A 30-year-old male presented with cough, cold, and myalgia symptoms for several days. An ECG was performed which showed the following abnormalities: positive P waves, right axis deviation, and reversal of the normal QRS pattern with the tallest amplitude in V1 diminishing to V6. Chest X-ray and echocardiogram revealed dextrocardia with situs inversus totalis, a rare condition where the internal organs are mirrored. The ECG findings are consistent with this anatomical anomaly.
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2) Errors in chest lead placement such as reversals of V1-V3 leads and incorrect electrode placement.
3) Examples of specific lead errors like left arm-left leg reversal that can cause changes in the appearance of inferior infarcts.
4) How a right arm-right leg reversal leads to lead II appearing "collapsed" with a very small QRS complex.
Eletrocardiograma
1) O documento discute os conceitos e base teórica para interpretação do eletrocardiograma (ECG), explicando como a atividade elétrica do coração é registrada e como pode ser afetada por diferentes fatores.
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Artificial heart
The document discusses the history and development of total artificial hearts (TAH) as a treatment for end-stage heart failure. It outlines how TAHs serve as a bridge to transplantation for patients waiting on donor organs. Several TAH devices are described, including the Jarvik 7, SynCardia, AbioCor, and CardioWest models. The document also notes some limitations of TAHs but that they provide a viable alternative for patients in need of heart transplants.
ECG CHALLENGE
This document provides descriptions of various ECG patterns and cardiac conditions:
- It describes limb lead reversal showing a sine wave pattern typical of hyperkalemia. Calcium gluconate and other treatments are recommended.
- Accelerated idioventricular rhythm is defined as having a rate between 50-100 bpm and being a type of slow ventricular tachycardia that does not typically require treatment.
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Artificial heart
The document describes the design of an artificial heart called the AbioCor. It discusses the need for heart substitutes due to the large number of patients needing heart transplants. The AbioCor uses a hydraulic pump powered by an internal battery to pump blood to the lungs and body, mimicking the function of the human heart. Its design aims to meet criteria such as providing adequate blood flow, preventing blood clots and immune responses, and having a self-contained system without external wires.
Powerpoint Artificial Heart
Dr. Robert Jarvik invented the artificial heart in the 1970s to help patients suffering from heart disease. The artificial heart works as a replacement for a failing heart by pumping blood through the body. It made America's list of greatest inventions because it extended many lives by giving patients more time until a heart transplant could be performed.
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This document describes the case of a 55-year-old hypertensive woman who presented to the emergency department with chest pain. She was diagnosed with an acute anterior wall myocardial infarction complicated by ventricular septal rupture based on her symptoms, ECG findings, cardiac enzymes, and echocardiogram. Her condition deteriorated with the development of a systolic murmur and cardiogenic shock. She was treated with inotropic support and taken for urgent surgery to repair the ventricular septal defect. The key points are: 1) Ventricular septal rupture occurs in 1-2% of myocardial infarctions and is associated with high mortality without surgery; 2) Echocardiogram and cardiac catheterization are important for diagnosis
Pericardial disease
Pericardial disease can present as acute pericarditis, pericardial effusion/cardiac tamponade, or constrictive pericarditis. Acute pericarditis causes sharp chest pain and a pericardial friction rub. Pericardial effusions can cause cardiac tamponade seen by increased jugular venous pressure and pulsus paradoxus. Constrictive pericarditis restricts heart filling seen by hepatomegaly and ascites. Causes include tuberculosis, infection, or post-surgery. Treatment involves identifying the cause, pericardiocentesis for large effusions, and pericardiectomy for constrictive pericarditis.
Congenital Heart diseases
This document discusses cardiac disorders that occur during fetal development and after birth. It describes how the heart and circulation develop in utero, with structural shunts that allow blood to bypass the lungs. After birth, these shunts normally close as pulmonary resistance drops and oxygen levels rise. Abnormalities can occur if these shunts persist after birth or if septation fails during development. Examples of specific congenital heart defects discussed include patent ductus arteriosus, atrial septal defect, ventricular septal defect, coarctation of the aorta, and transposition of the great arteries.
Cardio Vascular Reflex
This document discusses cardiovascular reflexes that regulate heart rate and blood vessel function. It describes the three main components of cardiovascular reflexes - afferent nerves, the central nervous system, and efferent nerves. It then discusses various reflexes in more detail, including the baroreceptor reflex, cardiac baroreflex, chemoreceptor reflex, and others. The baroreceptor reflex, detected by stretch receptors in blood vessels, acts as an important negative feedback loop to maintain blood pressure homeostasis.
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This document discusses various types of atrial and junctional dysrhythmias seen on electrocardiograms (ECGs), including atrial fibrillation, flutter, tachycardia, and premature atrial contractions as well as junctional rhythms, accelerated junctional rhythms, tachycardias, and premature junctional contractions. Mechanisms and treatments for supraventricular tachycardia are explained, including catheter ablation procedures to treat conditions like Wolff-Parkinson-White syndrome.
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This presentation is about the important aspect of cardiovascular system of equine in course equine veterinary medicine.
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Aortic incompetence is an anatomical defect of the aortic valve where the cups are deformed, sclerotic, calcified, decreased in volume, and unable to close the aortic orifice properly. This allows blood to flow backward from the aorta into the left ventricle during diastole, increasing the intraventricular pressure and blood volume. Over time this causes left ventricular hypertrophy and dilation, displacing the heart borders and apex beat to the left. Symptoms include a diastolic murmur, water hammer pulse, increased arterial pressure, and displaced apex beat. Diagnosis is made through ECG, chest x-ray, and echocardiogram showing valve abnormalities and ventricular changes.
Finaale pulmonary stenosis
This document discusses pulmonary stenosis (PS), a congenital heart defect where the pulmonary valve is narrowed. It accounts for 20-30% of congenital heart disease. PS can be valvular, subvalvular, or supravalvular. Symptoms range from none to right heart failure. Diagnosis involves listening for a systolic murmur and click, and imaging like echocardiogram and catheterization to measure pressures and gradients. Treatment is usually balloon valvuloplasty or surgery if severe.
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The document discusses the structure and function of different types of hearts. It explains that in animals with open circulatory systems, the heart is usually sac-like or tubular with openings that close during contraction and open during relaxation, causing blood to be sucked into the heart. These hearts are known as suction pumps. In higher animals with closed circulatory systems, the heart has 2-4 chambers with muscular ventricles that pump blood under pressure, making them pressure pumps. The document then focuses on pacemaker cells that set the rhythm of myogenic hearts in vertebrates and some invertebrates.
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The document provides information about the anatomy and physiology of the heart. It discusses the heart's location in the chest, its chambers and valves, the conduction system that coordinates heart contractions, and how heart rate is regulated. Key points include:
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Ventricular septum rupture after awmi By Dr. Haseeb Raza Naqvi
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A Case of Sheehan's Syndrome
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Imaging: Cortical Vein Thrombosis
A 35-year-old male chronic alcoholic presented with a week-long headache and blurry vision. On examination, he had right lateral rectus palsy. CT brain showed hyperdensity in the right frontal region, right transverse sinus, and hypodensity in the superior sagittal sinus, suggestive of parenchymal hemorrhage with cortical vein thrombosis or calcified granuloma. MRI brain found a hemorrhagic lesion in the right high parietal lobe, absence of flow voids in sinuses, and T1 hyperintensity in sinuses confirming sinus thrombosis, which was shown on MR venography. The patient was diagnosed with cerebral vein thrombosis based on imaging findings.
ECG: Findings in CNS disorders
A 73-year-old male presented with left upper and lower limb weakness. He has a history of diabetes and hypertension. On examination, his pulse was 64 beats/min, blood pressure was 160/100 mmHg, and he had left-sided hemiplegia. An ECG showed normal sinus rhythm, prolonged QT interval of 500ms, and deep anterolateral T wave inversions, which could be due to central nervous system involvement or myocardial ischemia. ECG findings associated with acute central nervous system disorders include prolonged QT interval and deeply inverted T waves in precordial leads.
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IMAGING: NEUROCYSTICERCOSIS
A 16-year-old boy was admitted with abnormal movements of his left thumb and left eyelid for over 1 hour. MRI scans showed lesions in his brain consistent with neurocysticercosis. Neurocysticercosis is caused by the pork tapeworm Taenia solium and has four pathogenic stages seen on imaging. The patient's symptoms, travel history, imaging findings, and positive blood tests confirmed a diagnosis of neurocysticercosis. He was treated with anti-seizure medications, anti-parasitic drugs, and steroids to reduce inflammation from degenerating parasites.
ECG: Digitalis Effect / MAT / AF
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.
Imaging: BOOP
A 28-year-old male presented with cough, dyspnea, fever, malaise, and weight loss. Chest X-ray and CT scan showed bilateral heterogeneous airspace opacities. He did not improve with antibiotics but responded well to steroids, suggestive of idiopathic bronchiolitis obliterans organizing pneumonia (BOOP). BOOP is a non-specific inflammatory reaction of small airways that can be idiopathic or secondary to various causes. It is treated with steroids and immunosuppressants if unresponsive to steroids.
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A Case of Idiopathic Pulmonary Hypertension
The document describes a case of a 35-year-old female admitted with complaints of breathlessness, swelling of the legs, and abdominal distension. On examination, she had elevated jugular venous pressure, enlarged liver, edema, and signs of right heart failure. Tests showed pulmonary hypertension, right ventricular dilatation, and cardiomegaly. She was diagnosed with severe pulmonary hypertension of unknown cause.
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A Case of Emphysematous Pylonephritis
A 50-year-old lady presented with shortness of breath, fever, cough with sputum production, and swelling of both legs over the past two days. She has a history of type 2 diabetes and hypertension. Examination found decreased breath sounds and mild dehydration. Investigations showed diabetic ketoacidosis, urinary tract infection with E. coli growth, and cirrhosis of the liver. She was diagnosed with type 2 diabetes, hypertension, emphysematous pyelonephritis, and transferred to urology for further management.
Imaging: Multiple Pulmonary Cavitary Lesions
A 38-year-old male smoker presented with swelling all over the body for the past 4 months. Examination revealed pitting pedal edema. Investigations showed elevated ESR, CRP and P-ANCA positivity. CT scan showed multiple cavitary lung lesions. A diagnosis of Wegener's granulomatosis was made based on clinical features, lab investigations and radiological findings.
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.
A Case of Hepato-Pulmonary Syndrome
This case involves a 35-year-old female with a history of non-cirrhotic portal fibrosis, splenectomy, recurrent tuberculosis, and recurrent bouts of hematemesis and fever. She presents with cyanosis, clubbing, and shortness of breath. Testing reveals findings consistent with hepatopulmonary syndrome, including low oxygen saturation that decreases further in an upright position. A contrast echocardiogram confirms intrapulmonary vascular dilations. She is diagnosed with severe, longstanding hepatopulmonary syndrome secondary to non-cirrhotic portal hypertension.
A Case of Thalassemia
A 25-year-old male presented with a history of anemia since childhood. Examination found pallor and hepatosplenomegaly. Investigations revealed microcytic hypochromic anemia and bone marrow aspiration showed erythroid hyperplasia consistent with thalassemia intermedia. Patients with thalassemia intermedia have variable clinical presentations between thalassemia major and minor, and may require lifelong monitoring and chelation therapy to manage iron overload from ineffective erythropoiesis.
A Case of Renal Amyloidosis
The document summarizes the case of a 60-year-old male admitted with generalized swelling of the body for 20 days. Investigations revealed IgA monoclonal gammopathy and renal biopsy showed features of amyloidosis. The patient was diagnosed with primary amyloidosis (AL type) associated with hepatitis B infection. Treatment with diuretics and antibiotics improved his symptoms and kidney function recovered.
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ECG: Dextrocardia
- 1. .. ECG OF THEECG OF THE WEEKWEEK Dr.B.Gowrishankar.Dr.B.Gowrishankar. Prof.G.Sundaramurthy’s unit.Prof.G.Sundaramurthy’s unit.
- 2. Clinical History:Clinical History: 30 yrs old male30 yrs old male h/o cough, cold x 3 daysh/o cough, cold x 3 days Severe myalgia x 1 daySevere myalgia x 1 day O/EO/E AfebrileAfebrile Vitals stableVitals stable
- 4. ECG SHOWSECG SHOWS Rate-60 /minRate-60 /min Rhythm-Normal sinus rhythmRhythm-Normal sinus rhythm P wave-Inverted in L1, aVL.P wave-Inverted in L1, aVL. Slightly upright in aVRSlightly upright in aVR PR interval-0.16 sPR interval-0.16 s QRS Complex:QRS Complex: width-0.08 swidth-0.08 s axis-RAD-100*axis-RAD-100*
- 5. Contd.,Contd., Configuration-Configuration- 1. Reversal of QRS pattern.1. Reversal of QRS pattern. Tallest in V1 and progressivelyTallest in V1 and progressively dimnishing to lead V6.dimnishing to lead V6. 2.slurring of downstroke of2.slurring of downstroke of QRS in L2QRS in L2 3.’M’ pattern in L2,L33.’M’ pattern in L2,L3
- 6. Contd.,Contd., ST segment- Isoelectric in all leads exceptST segment- Isoelectric in all leads except L2 and L3.L2 and L3. T wave- Inverted in L1,aVL,V2-V6.T wave- Inverted in L1,aVL,V2-V6. isoelectric in aVR.isoelectric in aVR. COMMENTS:COMMENTS: 1.Positive P waves.1.Positive P waves. 2.Right axis deviation.2.Right axis deviation. 3.Reversal of QRS pattern.3.Reversal of QRS pattern.
- 7. CONCLUSION:CONCLUSION: CXR – Dextrocardia.CXR – Dextrocardia. ECHO- Situs inversus totalis.ECHO- Situs inversus totalis.
- 8. DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS:: Reversal of limb leads:Reversal of limb leads: (Incorrectly placed arm electrodes)(Incorrectly placed arm electrodes) The precordial leads will showThe precordial leads will show normal QRS pattern.normal QRS pattern.
- 9. FEW DEFINITIONSFEW DEFINITIONS:: DEXTROCARDIA-DEXTROCARDIA- 1.Isolated dextrocardia is transposition of the heart1.Isolated dextrocardia is transposition of the heart without accompanying alteration of the abdominalwithout accompanying alteration of the abdominal viscera.viscera. 2.Mirror-image dextrocardia-location of the heart in the2.Mirror-image dextrocardia-location of the heart in the right side of chest, the atria being transposed and rightright side of chest, the atria being transposed and right ventricle lying anteriorly and left of the left ventricle.ventricle lying anteriorly and left of the left ventricle. DEXTROPOSITION OF THE HEART- A congenitalDEXTROPOSITION OF THE HEART- A congenital anomaly in which an anatomically correct heart isanomaly in which an anatomically correct heart is displaced to the right in thoracic cavity.displaced to the right in thoracic cavity.
- 10. SIGNIFICANCE:SIGNIFICANCE: 11. When dextrocardia occurs with situs inversus. When dextrocardia occurs with situs inversus the heart is most frequently normal.the heart is most frequently normal. 22. When dextrocardia occurs without situs. When dextrocardia occurs without situs inversus, when the visceral situs isinversus, when the visceral situs is indeterminate (indeterminate (situs ambigussitus ambigus) or if isolated) or if isolated levocardia is present complex multiplelevocardia is present complex multiple anomalies are usually present.anomalies are usually present. 33. Dextrocardia with situs solitus or situs. Dextrocardia with situs solitus or situs ambigus is less common and the incidence ofambigus is less common and the incidence of CHD is extremely high, probably 90%or greater.CHD is extremely high, probably 90%or greater.