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PROF. DR.RAMASAMY’S UNIT G.BALAJI MD PG
<ul><li>45 YEAR FEMALE PRESENTED WITH C/O </li></ul><ul><li>PALPITATION FOR 1 MONTH </li></ul><ul><li>EXERTIONAL BREATHLES...
 
 
 
<ul><li>SINUS RHYTHM </li></ul><ul><li>RATE 120/MIN </li></ul><ul><li>REGULAR RHYTHM </li></ul><ul><li>P WAVE DURATION- 0....
<ul><li>LEFT ATRIAL ENLARGEMENT </li></ul><ul><li>WIDE NOTCHED P WAVE IN I, V4 TO V6 </li></ul><ul><li>DURATION OF P WAVE ...
<ul><li>RIGHT ATRIAL ENLARGEMENT </li></ul><ul><li>TALL INITIAL COMPONENT OF P WAVE IN LEADS II, III, Avf. </li></ul><ul><...
<ul><li>RIGHT VENTRICLE ENLARGEMENT </li></ul><ul><li>TALL R WAVE IN LEAD VI </li></ul><ul><li>RIGHT AXIS DEVIATION. AROUN...
<ul><li>EVIDENCE OF PULMONARY HYPERTENSION  </li></ul><ul><li>RIGHT ATRIAL ENLARGEMENT </li></ul><ul><li>RIGHT AXIS DEVIAT...
<ul><li>DIGITALIS EFFECT </li></ul><ul><li>SHORTENED QTC INTERVAL </li></ul><ul><li>MIRROR IMAGE OF CHECK OR CORRECTION MA...
<ul><li>MITRAL STENOSIS WITH LEFT ATRIAL ENLARGEMENT , RIGHT ATRIAL ENLARGEMENT AND  PULMONARY HYPERTENSION WITH DIGITALIS...
<ul><li>ST SEGMENT </li></ul><ul><li>STRAIGHT DOWNWARD SLOPE WITH TERMINAL RISE IS MIRROR IMAGE OF  CHECK OR CORRECTION MA...
<ul><li>SHORTENING OF QTC INTERVAL </li></ul><ul><li>DIGITALIS ACCELARATE ACTIVITY OF VENTRICULAR SUB ENDOCARDIUM AND SHOR...
<ul><li>ABNORMAL CARDIAC RHYTHM </li></ul><ul><li>CAUSES ALL  ARRYTHMIAS EXCEPT TYPE II 2 ND  DEGREE AV BLOCK.VENTRICULAR ...
 
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ECG: Digitalis Effect

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ECG: Digitalis Effect

  1. 1. PROF. DR.RAMASAMY’S UNIT G.BALAJI MD PG
  2. 2. <ul><li>45 YEAR FEMALE PRESENTED WITH C/O </li></ul><ul><li>PALPITATION FOR 1 MONTH </li></ul><ul><li>EXERTIONAL BREATHLESSNESS FOR 2 MONTHS. </li></ul><ul><li>ON AUSCULTATION THE PATIENT HAD A DIASTOLIC MURMUR </li></ul>
  3. 6. <ul><li>SINUS RHYTHM </li></ul><ul><li>RATE 120/MIN </li></ul><ul><li>REGULAR RHYTHM </li></ul><ul><li>P WAVE DURATION- 0.12 SECONDS </li></ul><ul><li>FRONTAL PLANE P WAVE AXIS-AROUND 45 DEGREE </li></ul><ul><li>QT INTERVAL- 320 MILLISECONDS </li></ul><ul><li>QTC INTERVAL- 420 MILLISECONDS </li></ul><ul><li>QRS - RIGHT AXIS DEVIATION. 140 DEGREES </li></ul>
  4. 7. <ul><li>LEFT ATRIAL ENLARGEMENT </li></ul><ul><li>WIDE NOTCHED P WAVE IN I, V4 TO V6 </li></ul><ul><li>DURATION OF P WAVE IN LEAD I IS 0.12 SEC, NOTCH 0.04 SECONDS </li></ul><ul><li>DELAY IN INSCRIPTION OF TERMINAL DEFLECTION OF P WAVE INLEAD VI IS 0.08 SECONDS </li></ul>
  5. 8. <ul><li>RIGHT ATRIAL ENLARGEMENT </li></ul><ul><li>TALL INITIAL COMPONENT OF P WAVE IN LEADS II, III, Avf. </li></ul><ul><li>AMPLITUDE OF P IN LEAD II IS 3 MM [NORMAL 2MM] </li></ul><ul><li>P TRICUSPIDALE </li></ul><ul><li>INITIAL COMPONENT OF P WAVE TALLER THAN TERMINAL COMPONENT </li></ul>
  6. 9. <ul><li>RIGHT VENTRICLE ENLARGEMENT </li></ul><ul><li>TALL R WAVE IN LEAD VI </li></ul><ul><li>RIGHT AXIS DEVIATION. AROUND 140 DEGREE </li></ul><ul><li>T INVERSION IN LFEAD V1 TO V3 INDICATING A POSTERIOR DEVIATION OF T WAVE </li></ul><ul><li>rs COMPLEX IN V4 TO V6. CLOCKWISE ELECTRICAL ROTATION </li></ul>
  7. 10. <ul><li>EVIDENCE OF PULMONARY HYPERTENSION </li></ul><ul><li>RIGHT ATRIAL ENLARGEMENT </li></ul><ul><li>RIGHT AXIS DEVIATION </li></ul><ul><li>CLOCKWISE ELECTRICAL ROTATION </li></ul>
  8. 11. <ul><li>DIGITALIS EFFECT </li></ul><ul><li>SHORTENED QTC INTERVAL </li></ul><ul><li>MIRROR IMAGE OF CHECK OR CORRECTION MARK IN LEADS V1 TO V3 </li></ul><ul><li>NO DEPRESSION OF PROXIMAL PART OF ST SEGMENT </li></ul>
  9. 12. <ul><li>MITRAL STENOSIS WITH LEFT ATRIAL ENLARGEMENT , RIGHT ATRIAL ENLARGEMENT AND PULMONARY HYPERTENSION WITH DIGITALIS EFFECT </li></ul>
  10. 13. <ul><li>ST SEGMENT </li></ul><ul><li>STRAIGHT DOWNWARD SLOPE WITH TERMINAL RISE IS MIRROR IMAGE OF CHECK OR CORRECTION MARK IN LEADS WITH DOMINANTLY UPRIGHT QRS COMPLEX </li></ul><ul><li>T WAVE </li></ul><ul><li>THERAPEUTIC DOSES DIMNISH MAGNITUDE BUT NOT DIRECTION OF T WAVE. </li></ul><ul><li>TOXIC DOSES CHANGE DIRECTION OF T WAVE OR T WAVE DONOT RISE ABOVE THE BASELINE. </li></ul>
  11. 14. <ul><li>SHORTENING OF QTC INTERVAL </li></ul><ul><li>DIGITALIS ACCELARATE ACTIVITY OF VENTRICULAR SUB ENDOCARDIUM AND SHORTENS THE RECOVERY PERIOD. </li></ul><ul><li>QTC IS SHORTENED. IT OCCURS EARLY DURING COURESE OF DIGITALIS ADMINISTRATION. </li></ul><ul><li>SHORTENS THE REFRACTORY PERIOD OF ATRIAL MYOCARDIUM </li></ul><ul><li>LENGTHENS THE REFRACTORY PERIOD OF SA AND AV NODE </li></ul>
  12. 15. <ul><li>ABNORMAL CARDIAC RHYTHM </li></ul><ul><li>CAUSES ALL ARRYTHMIAS EXCEPT TYPE II 2 ND DEGREE AV BLOCK.VENTRICULAR EXTRASYSTOLES , BIGEMINI, VENTRICULAR TACHYCARDIAS, AV BLOCKS. </li></ul><ul><li>DIGITALIS HAS NO EFFEFT ON QRS COMPLEXES </li></ul><ul><li>MAY AT TIMES CAUSE PROMINENCE OF U WAVE </li></ul>

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