This document presents the case of a 17-year-old male with cyanotic congenital heart disease who was admitted to the emergency room after ingesting rat killer powder. His ECG shows findings consistent with Tetralogy of Fallot, including right ventricular hypertrophy, right atrial enlargement, and a strain pattern. Tetralogy of Fallot is described as a congenital heart disease consisting of four defects: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. The severity and treatment depend on the degree of pulmonary stenosis and size of the ventricular septal defect.
Right atrial overload (P pulmonale) and right ventricular hypertrophy. Right atrial overload (enlargement) is manifest as tall sharp P waves in lead II and V1. The cut off values are P wave amplitude more than 0.25 mV in lead II and 0.1 mV or more in V1. Dominant R waves in V1 and deep S waves in V6 indicate right ventricular hypertrophy (RVH). Sokolow-Lyon for RVH criteria mentions that R wave in V1 + S wave in V5/V6 should be 1.1 mV or more. There is also a clockwise rotation in the QRS pattern between V1 to V6. QRS axis is around +120 degrees (aVR biphasic and lead III showing tallest QRS complex). Right axis deviation is also due to right ventricular hypertrophy. T wave inversion in inferior leads and V1 could be due to right ventricular hypertrophy itself. RVH in this case is type A with dominant R in V1 and deep S in V6. This type is seen in pulmonary stenosis. Type B RVH shows dominant R waves in V1 without deep S in V6. Deep S in V6 without dominant R in V1 seen in chronic obstructive lung disease with cor-pulmonale is called type C RVH. (Strictly speaking the types are classified depending upon vector cardiographic features and not based on scalar ECG)
Right atrial overload (P pulmonale) and right ventricular hypertrophy. Right atrial overload (enlargement) is manifest as tall sharp P waves in lead II and V1. The cut off values are P wave amplitude more than 0.25 mV in lead II and 0.1 mV or more in V1. Dominant R waves in V1 and deep S waves in V6 indicate right ventricular hypertrophy (RVH). Sokolow-Lyon for RVH criteria mentions that R wave in V1 + S wave in V5/V6 should be 1.1 mV or more. There is also a clockwise rotation in the QRS pattern between V1 to V6. QRS axis is around +120 degrees (aVR biphasic and lead III showing tallest QRS complex). Right axis deviation is also due to right ventricular hypertrophy. T wave inversion in inferior leads and V1 could be due to right ventricular hypertrophy itself. RVH in this case is type A with dominant R in V1 and deep S in V6. This type is seen in pulmonary stenosis. Type B RVH shows dominant R waves in V1 without deep S in V6. Deep S in V6 without dominant R in V1 seen in chronic obstructive lung disease with cor-pulmonale is called type C RVH. (Strictly speaking the types are classified depending upon vector cardiographic features and not based on scalar ECG)
Right atrial overload (P pulmonale) and right ventricular hypertrophy. Right atrial overload (enlargement) is manifest as tall sharp P waves in lead II and V1. The cut off values are P wave amplitude more than 0.25 mV in lead II and 0.1 mV or more in V1. Dominant R waves in V1 and deep S waves in V6 indicate right ventricular hypertrophy (RVH). Sokolow-Lyon for RVH criteria mentions that R wave in V1 + S wave in V5/V6 should be 1.1 mV or more. There is also a clockwise rotation in the QRS pattern between V1 to V6. QRS axis is around +120 degrees (aVR biphasic and lead III showing tallest QRS complex). Right axis deviation is also due to right ventricular hypertrophy. T wave inversion in inferior leads and V1 could be due to right ventricular hypertrophy itself. RVH in this case is type A with dominant R in V1 and deep S in V6. This type is seen in pulmonary stenosis. Type B RVH shows dominant R waves in V1 without deep S in V6. Deep S in V6 without dominant R in V1 seen in chronic obstructive lung disease with cor-pulmonale is called type C RVH. (Strictly speaking the types are classified depending upon vector cardiographic features and not based on scalar ECG)
Right atrial overload (P pulmonale) and right ventricular hypertrophy. Right atrial overload (enlargement) is manifest as tall sharp P waves in lead II and V1. The cut off values are P wave amplitude more than 0.25 mV in lead II and 0.1 mV or more in V1. Dominant R waves in V1 and deep S waves in V6 indicate right ventricular hypertrophy (RVH). Sokolow-Lyon for RVH criteria mentions that R wave in V1 + S wave in V5/V6 should be 1.1 mV or more. There is also a clockwise rotation in the QRS pattern between V1 to V6. QRS axis is around +120 degrees (aVR biphasic and lead III showing tallest QRS complex). Right axis deviation is also due to right ventricular hypertrophy. T wave inversion in inferior leads and V1 could be due to right ventricular hypertrophy itself. RVH in this case is type A with dominant R in V1 and deep S in V6. This type is seen in pulmonary stenosis. Type B RVH shows dominant R waves in V1 without deep S in V6. Deep S in V6 without dominant R in V1 seen in chronic obstructive lung disease with cor-pulmonale is called type C RVH. (Strictly speaking the types are classified depending upon vector cardiographic features and not based on scalar ECG)
COPD is associated with increased airway resistance, alveolar and pulmonary capillary destruction, air trapping, chronic hypoxemia and increased work of breathing. In an attempt to improve oxygenation of the blood, pulmonary vessels adjacent to underventilated alveoli tend to constrict (hypoxic reflex pulmonary vasoconstriction), increasing both pulmonary vascular resistance and the work of right heart i.e. COPD imposes chronic strain on the right side of heart resulting in cor pulmonale.
ECG/EKG changes in Chronic Obstructive Pulmonary Diseasesprithvi2911
COPD is associated with increased airway resistance, alveolar and pulmonary capillary destruction, air trapping, chronic hypoxemia and increased work of breathing. In an attempt to improve oxygenation of the blood, pulmonary vessels adjacent to underventilated alveoli tend to constrict (hypoxic reflex pulmonary vasoconstriction), increasing both pulmonary vascular resistance and the work of right heart i.e. COPD imposes chronic strain on the right side of heart resulting in cor pulmonale.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
COPD is associated with increased airway resistance, alveolar and pulmonary capillary destruction, air trapping, chronic hypoxemia and increased work of breathing. In an attempt to improve oxygenation of the blood, pulmonary vessels adjacent to underventilated alveoli tend to constrict (hypoxic reflex pulmonary vasoconstriction), increasing both pulmonary vascular resistance and the work of right heart i.e. COPD imposes chronic strain on the right side of heart resulting in cor pulmonale.
ECG/EKG changes in Chronic Obstructive Pulmonary Diseasesprithvi2911
COPD is associated with increased airway resistance, alveolar and pulmonary capillary destruction, air trapping, chronic hypoxemia and increased work of breathing. In an attempt to improve oxygenation of the blood, pulmonary vessels adjacent to underventilated alveoli tend to constrict (hypoxic reflex pulmonary vasoconstriction), increasing both pulmonary vascular resistance and the work of right heart i.e. COPD imposes chronic strain on the right side of heart resulting in cor pulmonale.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Overview on Edible Vaccine: Pros & Cons with Mechanism
ECG OF THE WEEK final final _114428.pptx
1. DR.P.M.LOGAPERUMAL
1ST YEAR POST GRADUATE
DEPARTMENT OF INTERNAL MEDICINE
M7 UNIT
PROF. DR.R.THILAKAVATHI MD
DR.MADHUSUDHANAN MD
DR.ELANGOVAN MD.
2. BRIEF HISTORY
17 year old male a k/c/o
cyanotic congenital heart
disease came to the ER with
alleged h/o ingestion of Rat
killer powder (1 packet
powder).
Patient was stabilized and
transferred to ward and
incidentally found to have
complaints of breathlessness.
MMRC grade 2 for 2 months.
3. PAST HISTORY:
Patient is a k/c/o CYANOTIC CONGENITAL
HEART DISEASE.
No other known medical comorbidities
PERSONAL HISTORY:
Non smoker non alcoholic
Normal bowel and bladder habits
Normal sleep and appetite
6. 12 LEAD NORMAL STANDARD
ECG
NORMAL SINUS RHYTHM
HR- 100 BPM
RIGHT AXIS DEVIATION
P PULMONALE IN LEAD II, V1
ST DEPRESSION IN LEADS II,
III, aVF, v3-6
T WAVE INVERSION IN LEAD II,
III, aVF v1-6.
Monophasic R wave in v1
>7mm
Rs COMPLEX IN V1-V6
DEEP S WAVE IN V5-V6
8. 2. Positive r wave in aVR and V1 with R
wave in V1 >7mm.
9. 3. P PULMONALE – P wave in lead II >2.5mm
P wave in V1 > 1.5 mm
Indicates Right atrial enlargement.
10. 4. Right ventricular strain pattern
ST depression and T wave inversion in leads
corresponding to the right ventricle:
*Right precordial leads V1- V4
*Inferior leads II, III, aVF, often most
pronounced in lead III as this is the most
rightward facing lead.
11. RIGHT VENTRICULAR
HYPERTROPHY
*Right axis deviation
*Tall R wave in V1 >7mm
*R wave taller than S wave in V1
*Rs complex from V1-V6
*P pulmonale in Lead II and V1
*Deep s waves in v5 and v6
12. TYPE A – Most recognizable type of RVH.
Tall R waves in V1, V2, V3. Monophasic R waves
in V1.
If S wave is present, the R wave is always taller
than the height of the S wave with an R/S ratio
>1.
V5 and V6 shows deeper S waves than R waves.
In type A the thickness of right ventricle is more
than left. And right ventricle is the dominant
ventricle.
This is commonly seen in severe pulmonary
stenosis, primary pulmonary hypertension,
mitral stenosis with severe pulmonary
hypertension.
13. TYPE B –
The R wave in V1 is slightly taller than the
S wave or R/S ratio >1.
V1 may also exibit rSr’ pattern.
This type of RVH is usually seen in ASD or
MS with mild to moderate Pulmonary
hypertension.
14. TYPE C RVH-
This type of RVH is frequently missed as R wave
in V1 is smaller than S.
Deep S wave is present in V1-V6.
This type of RVH is seen in COPD and acute
pulmonary embolism.
15. Tetralogy of Fallot
ECG findings of RIGHT VENTRICULAR
HYPERTROPHY WITH STRAIN PATTERN AND
RIGHT ATRIAL ENLARGEMENT DUE TO
PULMONARY STENOSIS.
ECG FINDINGS IN TOF:
1. Right axis deviation
2. Right atrial enlargement – P Pulmonale
3. RVH with strain pattern
4. Monophasic tall ‘R’ wave in V1.
5. Abrupt change to rS pattern in V2
16. Importance of Q wave and
R wave in V5-6 in TOF
1. Presence and depth of Q wave
2. Amplitude of R wave in V5 and V6
Determines the magnitude of pulmonary blood flow and
ventricular filling
Reduced pulmonary blood flow with underfilled
left ventricle will have rS patterns in leads V2-6
A good pulmonary flow and balanced shunt will
have well developed R waves in V5-6 and small Q
waves.
17. TETRALOGY OF FALLOT
A cyanotic congenital heart disease
consisting of 4 defects
1. Infundibular Pulmonary stenosis
2. Right ventricular hypertrophy
3. Overriding of aorta into right ventricle
4. Ventricular septal defect
18. TREATMENT AND
PROGNOSIS
Severity of the condition depends upon
1. Degree of PULMONARY STENOSIS
2. Size of ventricular septal defect.
Treatment plan :
Most symptomatic Patients require temporary shunt
surgery most probably BT shunt.
