Post on 10-Jul-2015
transcript
PROF. DR.RAMASAMY’S UNITG.BALAJI MD PG
45 YEAR FEMALE PRESENTED WITH C/OPALPITATION FOR 1 MONTHEXERTIONAL BREATHLESSNESS FOR 2
MONTHS.ON AUSCULTATION THE PATIENT HAD A
DIASTOLIC MURMUR
SINUS RHYTHMRATE 120/MINREGULAR RHYTHMP WAVE DURATION- 0.12 SECONDSFRONTAL PLANE P WAVE AXIS-AROUND 45
DEGREE QT INTERVAL- 320 MILLISECONDSQTC INTERVAL- 420 MILLISECONDS QRS - RIGHT AXIS DEVIATION. 140
DEGREES
LEFT ATRIAL ENLARGEMENTWIDE NOTCHED P WAVE IN I, V4 TO V6DURATION OF P WAVE IN LEAD I IS 0.12 SEC,
NOTCH 0.04 SECONDSDELAY IN INSCRIPTION OF TERMINAL
DEFLECTION OF P WAVE INLEAD VI IS 0.08 SECONDS
RIGHT ATRIAL ENLARGEMENTTALL INITIAL COMPONENT OF P WAVE IN
LEADS II, III, Avf.AMPLITUDE OF P IN LEAD II IS 3 MM [NORMAL
2MM]P TRICUSPIDALE INITIAL COMPONENT OF P WAVE TALLER
THAN TERMINAL COMPONENT
RIGHT VENTRICLE ENLARGEMENT TALL R WAVE IN LEAD VI RIGHT AXIS DEVIATION. AROUND 140
DEGREE T INVERSION IN LFEAD V1 TO V3
INDICATING A POSTERIOR DEVIATION OF T WAVE
rs COMPLEX IN V4 TO V6. CLOCKWISE ELECTRICAL ROTATION
EVIDENCE OF PULMONARY HYPERTENSION
RIGHT ATRIAL ENLARGEMENTRIGHT AXIS DEVIATIONCLOCKWISE ELECTRICAL ROTATION
DIGITALIS EFFECTSHORTENED QTC INTERVALMIRROR IMAGE OF CHECK OR CORRECTION
MARK IN LEADS V1 TO V3NO DEPRESSION OF PROXIMAL PART OF ST
SEGMENT
MITRAL STENOSIS WITH LEFT ATRIAL ENLARGEMENT , RIGHT ATRIAL ENLARGEMENT AND PULMONARY HYPERTENSION WITH DIGITALIS EFFECT
ST SEGMENT STRAIGHT DOWNWARD SLOPE WITH TERMINAL
RISE IS MIRROR IMAGE OF CHECK OR CORRECTION MARK IN LEADS WITH DOMINANTLY UPRIGHT QRS COMPLEX
T WAVE THERAPEUTIC DOSES DIMNISH MAGNITUDE BUT
NOT DIRECTION OF T WAVE. TOXIC DOSES CHANGE DIRECTION OF T WAVE OR
T WAVE DONOT RISE ABOVE THE BASELINE.
SHORTENING OF QTC INTERVALDIGITALIS ACCELARATE ACTIVITY OF
VENTRICULAR SUB ENDOCARDIUM AND SHORTENS THE RECOVERY PERIOD.
QTC IS SHORTENED. IT OCCURS EARLY DURING COURESE OF DIGITALIS ADMINISTRATION.
SHORTENS THE REFRACTORY PERIOD OF ATRIAL MYOCARDIUM
LENGTHENS THE REFRACTORY PERIOD OF SA AND AV NODE
ABNORMAL CARDIAC RHYTHMCAUSES ALL ARRYTHMIAS EXCEPT TYPE II 2ND
DEGREE AV BLOCK.VENTRICULAR EXTRASYSTOLES , BIGEMINI, VENTRICULAR TACHYCARDIAS, AV BLOCKS.
DIGITALIS HAS NO EFFEFT ON QRS COMPLEXES
MAY AT TIMES CAUSE PROMINENCE OF U WAVE