Special Visual Based Supplement (Cardiology)

Section 1

Q. 1 Supplement

Question Id: 5454446 Question Type: Subjective Max Marks :

Solution:
1.Atrial fibrillation

2.Digoxin toxicity 1

3.Digoxin toxicity 2

4.ECG OF HYPERKALEMIA
5.ECG OF HYPOKALEMIA

6.First Degree heart block

7.LBBB1

8.LBBB2
9.Second degree heart block

10.Spinter haemorrages

11.Third dergree heart block

12.Ventricular fibrillation
13.Infective endocarditis

14.RBBB

15.RBBB-1

16.Roth sports
17. Paradoxical pulse (radial artery pressure signal). The patient had severe tamponade. Note the exaggerated (>10mmHg) decline in arterial pressure during inspiration.

18. Kussmaul's sign. Jugular venous pressure recording in a patient with tamponade. The venous pressure is raised and there is a particularly prominent systolic 'x' descent, giving
the waveform of the JVP an unusually dynamic appearance. Note the inspiratory rise in atrial pressure (Kussmaul's sign) reflecting the inability of the tamponaded right heart to
accommodate the inspiratory increase in venous return.

19. Eruptive xanthomata in severe hypertriglyceridaemia.

20. Severe anterior wall ischemia (with or without infarction) may cause prominent T-wave inversions in the precordial leads. This pattern (sometimes referred to as Wellens T
waves) is usually associated with a high-grade stenosis of the left anterior descending coronary artery. (MI)

21. Difference in the approach to the lesion with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). PCI is targeted at the ''culprit''
lesion or lesions, whereas CABG is directed at the epicardial vessel, including the culprit lesion or lesions and future culprits, proximal to the insertion of the vein graft, a differenc
that may account for the superiority of CABG, at least in the intermediate term, in patients with multivessel disease (MI)

22. Xanthelasma (MI)

23. Primary PCI. (MI)
a.Acute right coronary artery occlusion.
b.Initial angioplasty demonstrates a large thrombus filling defect (arrows).
c.Complete restoration of normal flow following intracoronary stent insertion.
24. ECG in MI

25.

26. ECG in MI
27. Seldinger needle and guidewire for introducing an arterial catheter. (MI
28 Balloon catheter for percutaneous transluminal angioplasty.(MI)

29. (a) Catheter balloon deflated; (b) balloon inflated.(MI)

30. (a) Balloon catheters carrying stents; (b) non-expanded and expanded stents (MI)

31. Comparison of typical QRS-T patterns in right bundle branch block (RBBB) and left bundle branch block (LBBB) with the normal pattern in leads V1 and V6 . Note the

secondary T-wave inversions (arrows) in leads with an rSR' complex with RBBB and in leads with a wide R wave with LBBB. (ECG)

32. Ventricular hypertrophy. (a) Left ventricular hypertrophy. The QRS voltage deflections are exaggerated such that the sum of S and R waves in V1 and V6, respectively, exceed
35 mm. T-wave inversion in V5 and V6 indicates left ventricular 'strain'. (b) Right ventricular hypertrophy. Prominent R waves in V1 and V2 associated with T-wave inversion are
shown.
33. The earliest ECG change with hyperkalemia is usually peaking (''tenting'') of the T waves. With further increases in the serum potassium concentration, the QRS complexes
widen, the P waves decrease in amplitude and may disappear, and finally a sine-wave pattern leads to asystole unless emergency therapy is given. (ECG)
34. A variety of metabolic derangements, drug effects, and other factors may prolong ventricular repolarization with QT prolongation or prominent U waves. Prominent
repolarization prolongation, particularly if due to hypokalemia, inherited ''channelopathies,'' or certain pharmacologic agents, indicates increased susceptibility to torsades des
pointes-type ventricular tachycardia (Chap. 233). Marked systemic hypothermia is associated with a distinctive convex ''hump'' at the J point (Osborn wave, arrow) due to altered
ventricular action potential characteristics. Note QRS and QT prolongation along with sinus tachycardia in the case of tricyclic antidepressant overdose. (ECG)

36. Prolongation of the Q-T interval (ST-segment portion) is typical of hypocalcemia. Hypercalcemia may cause abbreviation of the ST segment and shortening of the QT interv
(ECG)
37 ECG in hyperkalemia

38. Prolonged sinus arrest. After the fifth sinus beat there is a pause of about 1.8 seconds terminated by a nodal escape beat (arrowed) before sinus rhythm resumes.

39 Coronary arteriograms. (a) Left anterior descending disease (arrowed). This tight stenosis threatens the coronary supply to the anterior wall of the left ventricle. (b) Right
coronary artery disease (arrowed). Serial stenoses in this dominant right coronary artery threaten the supply to the inferior wall of the heart.
40. Chest X-ray in acute left ventricular failure: the patient had severe pulmonary oedema caused by acute myocardial infarction. The heart is not yet enlarged, but there is promine
alveolar pulmonary oedema in a perihilar ('bat's-wing') distribution. Note the bilateral pleural effusions.

41. Poor oral hygiene in a patient with infective endocarditis (endocarditis)

42 Splinter haemorrhage (endocarditis)

43. Vasculitis in a patient with infective endocarditis (endocarditis)

44. Hypertensive retinopathy with scattered flame (splinter) hemorrhages and cotton-wool spots (nerve fiber layer infarcts) in a patient with headache and a blood pressure of
234/120. (HT)

45. Retinal changes in hypertension. (HT)

A.Grade 4 hypertensive retinopathy showing swollen optic disc, retinal haemorrhages and multiple cotton wool spots (infarcts).
BCentral retinal vein thrombosis showing swollen optic disc and widespread fundal haemorrhage, commonly associated with systemic hypertension.

46. Simple hand-held Doppler ultrasound probe. (HT)

47. Erythema marginatum (RHD)

48. Pulmonary oedema in acute renal failure. The appearances are indistinguishable from left ventricular failure but the heart size is usually normal. Blood pressure is often high
(CHF)
48. Pitting oedema, right hand.