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best heart doctors An 83-year-old man was evaluated for frequent palpitations. During an episode, examination of the neck revealed rapid and regular pulsations with bulging of the internal jugular veins .A 12-lead electrocardiogram was obtained and showed a regular, narrow-complex tachycardia, with narrow P waves deforming the terminal QRS complex (Panel A, arrowheads). The P wave is negative in the inferior leads (forming a pseudo-S wave) and positive in lead V1 (forming a pseudo-r′ wave). On the application of pressure to the carotid sinus, the tachycardia and the bulging of the internal jugular veins were resolved .and sinus rhythm was restored. The characteristics of the arrhythmia were suggestive of atrioventricular nodal reentrant tachycardia, a functional reentrant arrhythmia localized to the AV junction. In its typical form, anterograde conduction occurs over the slow pathway to the ventricle, while near-simultaneous atrial activation occurs over the fast pathway of the AV node. These events lead to the parallel electrical activation of the atria and ventricles. Canon A waves result from the simultaneous contraction of the atria and ventricles against closed atrioventricular valves, causing a reflux of blood into the neck veins.
SAMIKSHA HEART AND DIABETIC CARE IN YELAHANKA Echocardiographic findings in certain cardiac abnormalities It is important to be aware that modern colour flow mapping is so sensitive that small amounts of regurgitation are often detected from quite normal valves. Deciding whether these jets are significant can be difficult and requires experience. Mitral stenosis Thickening and doming of the mitral valve leaflets is visible on M mode and 2D scanning , It may be possible to measure the valve area by planimetry . Secondary changes such as left atrial size and the presence of rheumatic disease of other valves can be seen. Doppler interrogation of the jet of blood entering the left ventricle through the mitral valve will enable estimation of the valve area by a formula called the pressure half-time equation This will usually give accurate and consistent estimates of the valve area and is especially useful for serial measurements over months or years. It will also be possible to detect associated mitral regurgitation with Doppler. Mitral regurgitation and mitral valve prolapse Here the mitral valve may appear normal and abnormal co-aptation of the leaflets is not usually visible . The left atrium will appear enlarged if significant chronic MR is present, and if this is severe left ventricular dilatation will be present. If the MR is due to mitral valve
heart doctors in Kattigenahalli, Bangalore • Impulse conduction Sinoatrial block Some instances of apparent sinus bradycardia are due to sinoatrial (SA) block; this can be ascertained only by observing variations in conduction ratios or characteristic periodicity, The sinoatrial node beats (yes, beats) continuously, 7 but some impulses are blocked from entering the atria. The pauses are often termed ‘sinoatrial block’ or ‘sinus arrest’; it is probably permissible to call them ‘sinus pauses’ for convenience. The upper strip shows typical Wenckebach (see below) grouping, with slight acceleration in the last two groups prior to pauses that themselves are shorter than two sinus cycles. The most likely interpretation is 3:2 and 4:3 SA exit block in this patient with known sick sinus syndrome . The lower strip, taken later, shows only sinus arrhythmia (waxing and waning of the sinus rate with respiration—a normal occurrence). Interatrial block The term LAA, of which abnormal interatrial conduction (block) is a major cause, has replaced the more elegant term P mitrale because mitral valve disease is only one cause of the condition. The P wave is prolonged to or beyond 0.10 seconds and is often notched ); the significant notching should have an inter-peak distance of at least 1 mm (0.04 seconds). It is thought to represent a lesion in Bachman’s bundle, the interatrial tract. Atrioventricular blocks Atrioventricular (AV) blocks delay (first-degree) or prevent some (second-degree) or all (third-degree) of the supraventricular impulses from reaching the ventricles. The blocks may be congenital or acquired, transient or permanent. The most clinically useful classification is based on their anatomical cause and their ECG manifestations. This classification also helps in
heart doctors in Kattigenahalli, Bangalore • Impulse conduction Sinoatrial block Some instances of apparent sinus bradycardia are due to sinoatrial (SA) block; this can be ascertained only by observing variations in conduction ratios or characteristic periodicity, The sinoatrial node beats (yes, beats) continuously, 7 but some impulses are blocked from entering the atria. The pauses are often termed ‘sinoatrial block’ or ‘sinus arrest’; it is probably permissible to call them ‘sinus pauses’ for convenience. The upper strip shows typical Wenckebach (see below) grouping, with slight acceleration in the last two groups prior to pauses that themselves are shorter than two sinus cycles. The most likely interpretation is 3:2 and 4:3 SA exit block in this patient with known sick sinus syndrome . The lower strip, taken later, shows only sinus arrhythmia (waxing and waning of the sinus rate with respiration—a normal occurrence). Interatrial block The term LAA, of which abnormal interatrial conduction (block) is a major cause, has replaced the more elegant term P mitrale because mitral valve disease is only one cause of the condition. The P wave is prolonged to or beyond 0.10 seconds and is often notched ); the significant notching should have an inter-peak distance of at least 1 mm (0.04 seconds). It is thought to represent a lesion in Bachman’s bundle, the interatrial tract. Atrioventricular blocks Atrioventricular (AV) blocks delay (first-degree) or prevent some (second-degree) or all (third-degree) of the supraventricular impulses from reaching the ventricles. The blocks may be congenital or acquired, transient or permanent. The most clinically useful classification is based on their anatomical cause and their ECG manifestations. This classification also helps in
the best cardiac centers in yelahanka Heart Valves Heart valves open when the heart pumps to allow blood to flow forward, and close quickly between heartbeats to make sure blood does not flow backward. Any problem with this normal flow will make it difficult for the heart to effectively pump the blood where it needs to go. The tricuspid valve sits between the right upper chamber (right atrium) and the right lower chamber (right ventricle). The tricuspid valve directs blood flow from the right upper chamber to the right lower chamber. The pulmonary valve directs blood flow from the right lower chamber (right ventricle) into the pulmonary artery, which splits into two arteries so that the blood from the body can get to both lungs. The mitral valve sits between the left upper chamber (left atrium) and left lower chamber. The mitral valve directs blood flow from the left upper chamber into the left lower chamber. The aortic valve directs blood from the left lower chamber (left ventricle) into the aorta. The aorta is the major blood vessel that leads from the left lower chamber to the rest of the body.
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