Spotters

DR PRAVEEN GUPTA

Moderator

DR Raja Selvaraj

Departement of Cardiology

JIPMER

Pondicherry, India

Date -29/02/2016

Spotter-1

20 years old female present to the JIPMER female cardiology OPD with

History of 8 months amenorrhea

Palpitation on and off since 1 month

Description of the ECG

Narrow complex regular

tachycardia

Heart rate=188/min

Normal axis

PR interval 120 msec

RP intrval 160 msec

P wave postive in lead 2,3,avf

Negative in Lead V1,V2

RP interval longer than PR interval

ECG diagnosis

Long RP tachycardia

Differential diagnosis

Atrial tachycarida

Atypical AVNRT

PJRT

Approach to a patient with narrow QRS tachycardia

Spotter-2

45 Years old female present to the JIPMER female OPD with history of

Recurrent palpitation since 2 months

Description of the ECG

NSR

69/min

PR interval 84 msec

Delta waves Negative in V1

Delta waves are Negative in lead II, III, avf

Diagnosis

WPW syndrome with Right Posteroseptal pathway

Approach to a patient with WPW syndrome

Spotter-3

55 year old male present to the JIPMER causality with one day history of

Palpitation

Chest pain

Dyspnoea

Description of the ECG

Narrow complex tachycardia

Rate 190/min

Negative P wave in lead II,III,

Avf

RP interval 120 msec

PR interval 240 msec

Diagnosis

Short RP interval narrow QRS

tachycardia

Differential Diagnosis

AVRT

AVNRT

Spotter-4

55 years old male present to the JIPMER cardiology emergency with 2

hours histroy of

Palpitation

Dyspnoea

Chest pain

ECHO-Structrually normal heart

Description of the ECG

Broad complex regular

tachycardia

HR=190/min

QRS duration200 msec

Infeior axis

LBBB morphology

Capture beat

Fusion beat

Differential diagnosis

RVOT VT

ARVD

Approach to a patient with Outflow tract VT in normal heart

Outflow tract VT

 In structurally normal hearts

Manifest as premature ventricular complexes (PVCs), salvos of VT, and

sustained VT

Exercise or emotional stress trigger VT

Prognosis favorable

Verapamil effective therapy

Catheter ablation very effective

Spotter-5

A 30 year old male present to the JIPMER cardiology OPD with chief

complaints of

Dyspnoea on exertion since childhood

Cyanosis since 1 year

Chest X-ray of patient done

Chest X-ray

Description of the chest X-ray

Chest X-ray s/o Dilated main pulmonary artery with dilated left and right

pulmonary artery

Decrease pulmonary vascularity

Dilated Right atrium, right ventricle

Diagnosis

Eisenmenger syndrome in a patient with atrial septal defects

Spotter-6

Description of Ventriculogram

RV ventriculogram shows reduced movement in the tricuspid and inferior

wall regions

 Localized akinetic or dyskinetic bulges, outpouchings, dilatation of the

infundibulum, trabecular hypertrophy, and/or disarray with deep fissures

Diagnosis-ARVD

Spotter-7

Description of the Cath Study

Percutaneous Aortic Valve Replacement for Severe Aortic Stenosis

Balloon valvuloplasty with a 20- to 23-mm balloon under rapid pacing was

performed before device placement, after which over a stiff guidewire,

placed in the left ventricle, the device was deployed retrogradely under

fluoroscopic guidance

Spotter-8Identify the foreign object in the Chest X-ray

Nanostim (Leadless Pacemaker)

St Jude Medical, introduce leadless pacemaker

Resides entirely in the right ventricle

No leads

No chest incision

No scar

No permanent lump under the skin  

Spotter-9Identify the foreign object in the Chest X-ray

Subcutaneous ICD

Novel defibrillator

Defibrillation lead completely outside the chest cavity

Terminate life-threatening arrthythmias