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'internal jugular veins'
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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.
HEART SPECIALISTS IN SILKBOARD Complex congenital heart disease: conduits Anatomy and physiology Babies with a very abnormal right ventricular outflow tract such as pulmonary atresia can have a conduit fashioned to direct blood from the systemic veins more directly to the pulmonary arterial circulation or from a systemic artery to the pulmonary circulation. These conduits are made from veins or occasionally from Gortex. 368 PRACTICAL CARDIOLOGY Complications Conduits of all types have a limited life and tend to deteriorate after 10 years. These patients are also at risk of ventricular arrhythmias and heart block. Follow-up Patients need regular expert echocardiography to assess the conduit function. The conduit may deteriorate significantly before symptoms occur. Further treatment Conduit deterioration is usually an indication for further surgery although it can occasionally be treated with balloon dilatation. Pregnancy and contraception Pregnancy is well tolerated in patients with good conduit function. There are no particular problems with contraception. Sports Patients should avoid competitive and contact sports.
Hypertensive retinopathy I Silver wiring of arteries II AV nipping (sclerotic arteries pressing on veins) III Haemorrhages and exudates IV Papilloedema associated with encephalopathy
Hypertensive retinopathy I Silver wiring of arteries II AV nipping (sclerotic arteries pressing on veins) III Haemorrhages and exudates IV Papilloedema associated with encephalopathy
Cardiology is a branch of medicine dealing with disorders of the heart as well as parts of the circulatory system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology. Physicians who specialize in this field of medicine are called cardiologists, a specialty of internal medicine. Pediatric cardiologists are pediatricians who specialize in cardiology.
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