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.

1. SPOTTERS
(ECG,CXR,ECHO, FLURO IMAGE)
DR MAHENDRA
Cardiology, JIPMER

2. Probable Diagnosis ?

3. AV Block: 2nd degree, Mobitz I
(Wenckebach Phenomenon)
• Progressive prolongation of the PR interval culminating in a
non-conducted P wave.
• The PR interval is longest immediately before the dropped
beat.
• The PR interval is shortest immediately after the dropped
beat.

4. • The P-P interval remains relatively constant.
• The greatest increase in PR interval duration is
typically between the first and second beats of the cycle.
• The RR interval progressively shortens with each beat of the
cycle.
• The Wenckebach pattern tends to repeat in P:QRS groups with
ratios of 3:2, 4:3 or 5:4.

5. • 40 year old male presented with complain of
• Palpitation
• Dyspnoea –III
• b/l pedal edema
• Family history- elder brother died at age of 30
year due to sudden cardiac arrest.

6. ? Probable diagnosis

7. ARVD
• Major echo criterion
• Regional RV akinesia, dyskinesia, or aneurysm
• and 1 of the following (end diastole)—
 PLAX RVOT ≥32 mm
 PSAX RVOT ≥36 mm
 fractional area change ≥33%
• Minor echo criterion
• Regional RV akinesia or dyskinesia
• and 1 of the following (end diastole)—
 PLAX RVOT ≥29 to <32 mm
 PSAX RVOT ≥32 to <36 mm
 fractional area change ≥33% to <40%

8. ? Probable Diagnosis

9. Brugada type 1
• Diagnostic Criteria
• Type 1 (Coved ST segment elevation >2mm in >1 of V1-V3
followed by a negative T wave) is the only ECG abnormality
that is potentially diagnostic. This has been referred to as
Brugada sign.

10. • ECG abnormality must be associated with one of the
following clinical criteria to make the diagnosis:
• Documented ventricular fibrillation (VF) or
polymorphic ventricular tachycardia (VT).
• Family history of sudden cardiac death at <45 years
old .
• Coved-type ECGs in family members.
• Inducibility of VT with programmed electrical
stimulation .
• Syncope.

11. ? Probable Diagnosis

12. Ashman phenomenon
• wide complex QRS complexes that follow a short R-R interval
preceded by a long R-R interval.

13. • Duration of the refractory period of the myocardium is
proportional to the R-R interval of the preceding cycle.
• A short R-R interval is associated with a shorter duration of
action potential and vice versa.
• A long R-R cycle will prolong the ensuing refractory period,
and if a shorter cycle follows, the beat terminating the cycle is
likely to be conducted aberrantly.
• Because the refractory period of the right bundle branch is
longer than the left, the right bundle will still be in the
refractory period when the supraventricular impulse reaches
the His-Purkinje system, resulting in a complex with right
bundle branch morphology.

16. Chest X-ray findings suggestive of
CAP include
Levoposition of the heart without
tracheal deviation, which may be
mistaken for cardiomegaly.
The right border is not seen because
it is superimposed on the spine on
frontal projection.
The left border is elongated and
flattened, with prominence of the
main pulmonary artery, which is
separated from the aortic knob by a
radiolucent zone (Snoopy's sign)
The 2-D echocardiogram findings
include
Right ventricular enlargement,
abnormal septal motion, cardiac
hypermobility with swinging motion
of the heart, and teardrop
appearance with bulbous ventricle
and elongated atria.
Another striking echocardiographic
findings include, failure to obtain
standard views via the usual
acoustic windows.
Congenital Absence of Pericardium

17. Problable echo image diagnosis?

18. • Tricuspid annular plane systolic excursion
(TAPSE)-
• distance of systolic excursion of the RV annular plane
towards the apex.
• obtained by M-mode cursor passed through the
tricuspid lateral annulus in a four-chamber view and
measuring the amount of longitudinal displacement of
the annulus at peak-systole.
• Normal value for TAPSE: above 16 mm.

19. Culprit artery localization ?

21. Probable diagnosis?

22. Constrictive pericarditis
• M-mode in parasternal short axis view at papillary muscles
level in constrictive pericarditis- septal bounce with abnormal
septum movement in early diastole (arrow).
• Other feature-

23. increased echogenicity in the region of
the pericardium

24. apical four-chamber view, pulse wave Doppler recording of
mitral inflow: inspiratory decrease in E-wave velocity

25. pulse wave Doppler recording of tricuspid
inflow: inspiratory increase in E-wave velocity by
35% (arrow)

26. THANK YOU