CARDIOLOGY

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CARDIOLOGY

مشاركةبواسطة دكتور كمال سيد » الجمعة نوفمبر 07, 2014 11:31 am

CARDIOLOGY

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http://www.themdsite.com/interactive_learning.cfm


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From Rapid Interpretation of EKG's copyright © 2014 COVER Publishing Co. Inc.


Myocardial infarction ("infarct") occurs when a coronary artery supplying the left ventricle becomes occluded by a thrombus (blood clot), so an area of the heart is without a blood supply.


The terms "myocardial INFARCTION," "coronary occlusion," and "heart attack" refer to the same serious problem.


The heart derives its own blood supply from the CORONARY arteries, so when a coronary artery or one of its major branches is occluded, an area of the myocardium is without blood supply.


The infarcted area is primarily in the LEFT ventricle, and deadly arrhythmias may result.


NOTE: We understand that the coronary arteries also supply the right ventricle, so there is often some involvement of the right ventricle.
But since most of the critical problems originate in left ventricular infarcts, myocardial infarction is usually conceptualized in terms of the left ventricle.


Commonly, the thick left ventricle suffers myocardial infarction.

The left ventricle is the thickest chamber of the heart; so if the coronary arteries are narrowed, the left
ventricle (which uses the greatest blood supply) is the first to suffer from an obstructed coronary
ARTERY

Blood is pumped to all parts of the body by the powerful, thick, LEFT ventricle.

NOTE: When we describe infarcts by location, we are speaking of an area of the left ventricle. Coronary arteries to the left ventricle usually send smaller branches to other regions of the heart, so an infarction of the left ventricle can include a small portion of another chamber.
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Re: CARDIOLOGY

مشاركةبواسطة دكتور كمال سيد » الجمعة نوفمبر 07, 2014 11:54 am

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On EKG the QRS complex represents ventricular contraction. The Q wave is the first downward wave of the QRS complex, and it is followed by an upward R wave, however the Q wave is often absent on EKG. Necrosis (death) of an area of the heart muscle produces a Q wave on EKG.


The Q wave, when present, always occurs at the BEGINNING of the QRS complex and is the first downward deflection of the complex.

The downward Q wave is followed by an upward R wave.


NOTE: If there is any upward deflection in a QRS complex that appears before a "Q" wave, it is not a Q wave, for by convention, when present, the Q wave is always the[color=#BF0000] first wave in the complex.
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The Q wave makes the diagnosis of infarction.

The diagnosis of myocardial infarction is usually based on the presence of significant Q waves that are produced by the area of necrosis.


NOTE: The Q wave is the first downward stroke of the QRS complex, and it is never preceded by anything in the complex. In the QRS complex, if there is any positive wave - even a tiny spike - before the downward wave, the downward wave is an S wave (and the upward wave preceding it is an R wave).


Significant Q are absent in normal tracings.


We use a capital "Q" to designate a significant Q wave,
however small "q" waves are not significant.
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Re: CARDIOLOGY

مشاركةبواسطة دكتور كمال سيد » الجمعة نوفمبر 07, 2014 12:46 pm

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If there are Q waves in lead I and lead AVL, there is a lateral infarction.


Please take a moment and glance at page 46 to make a mental note of the leads that have a positive electrode located laterally on the left arm.


A lateral infarction involves the lateral portion of the LEFT ventricle.


When a lateral infarction occurs, Q waves appear in leads I and AVL.


NOTE: One might abbreviate Lateral Infarction as L.I. Just remember AVL for "Lateral" and "I" for Infarction (after all, Roman Numeral "I" for lead I is just a capital "i"). It's an easy way to recall the leads that demonstrate lateral infarction.
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Re: CARDIOLOGY

مشاركةبواسطة دكتور كمال سيد » الجمعة نوفمبر 07, 2014 12:55 pm

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Inferior ("diaphragmatic") infarction is diagnosed by the presence of Q waves in II, III, and AVF.


The inferior wall of the heart rests upon the diaphragm, so the term "diaphragmatic" infarction is sometimes used to indicate an infarction in the inferior portion of the left
VENRICLE.


An INFERIOR infarction is identified by significant Q waves in leads II, III, and AVF.


NOTE: If I told you the way that I remember the leads for inferior infarction, this book would be banned. You may want to make your own memory tool for remembering the leads for Inferior ("diaphragmatic") Infarction using "two, three, and F."
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Re: CARDIOLOGY

مشاركةبواسطة دكتور كمال سيد » الجمعة نوفمبر 07, 2014 5:00 pm

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Digitalis causes a gradual down-sloping of the ST segment, to give it the appearance of Salvador Dali's mustache.
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Re: CARDIOLOGY

مشاركةبواسطة دكتور كمال سيد » الجمعة نوفمبر 07, 2014 5:07 pm

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Q waves in chest leads V1, V2, V3, or V4 signify an anterior infarction.


NOTE: The chest leads are mainly placed anteriorly on the chest, so this is a good way to remember the leads for anterior infarction.


The presence of Q waves in V1, V2, V3, or V4 indicates an infarction in the anterior wall of the LEFT ventricle.


NOTE: Statistically, anterior infarctions are very deadly, but fortunately, immediate treatment with intravenous thrombolytic medications or angioplasty with stenting has improved the survival rate substantially.
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Re: CARDIOLOGY

مشاركةبواسطة دكتور كمال سيد » الجمعة نوفمبر 07, 2014 5:19 pm

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It is common practice to determine the general location of an infarction, but with a little anatomical knowledge of the heart's coronary blood supply*, we can make a far more sophisticated diagnosis.


There are two coronary arteries that provide the heart with a continuous supply of oxygenated BLOOD .


Quickly review the illustration.
The Left Coronary Artery has two major branches; they are the Circumflex branch and the ANTERIOR Descending branch.


The Right Coronary Artery curves around the right VENTRICLE.


* The pulmonary artery has been "surgically" removed in this illustration to show the origin of the coronary arteries at the base of the aorta.
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Re: CARDIOLOGY

مشاركةبواسطة دكتور كمال سيد » الجمعة نوفمبر 07, 2014 5:30 pm

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A lateral infarction is caused by an occlusion of the Circumflex branch of the Left Coronary Artery. An anterior infarction is due to an occlusion of the Anterior Descending branch of the Left Coronary Artery.


The Circumflex branch of the Left Coronary Artery distributes
blood to the LATERAL portion of the left ventricle.


The Anterior Descending branch of the Left Coronary Artery
supplies blood to the anterior portion of the LEFT ventricle.


The Circumflex and the Anterior Descending are the two main
branches of the LEFT Coronary Artery.
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Re: CARDIOLOGY

مشاركةبواسطة دكتور كمال سيد » الجمعة نوفمبر 07, 2014 5:38 pm

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The base of the left ventricle receives its blood supply from branches of either the Right or the Left Coronary Artery, depending on which artery is "dominant."


Inferior ("diaphragmatic") infarctions are caused by an occluded
terminal branch of either the Right or the LEFT Coronary Artery.


So the diagnosis of inferior infarction does not necessarily identify
the artery branch that is occluded, unless you have a previous
coronary angiogram (an x-ray highlighting the coronary arteries)
to identify which CORONARY artery supplies the inferior portion
of that patient's left ventricle.


NOTE: Left or Right Coronary "dominance" denotes which coronary artery is the major source of blood supply to the base of the left ventricle. Right Coronary dominance is by far most common in humans.
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Re: CARDIOLOGY

مشاركةبواسطة دكتور كمال سيد » السبت إبريل 30, 2016 11:22 am

The following murmurs are heard best at the apex

[Hypertrophic obstructive cardiomyopathy [True]

[Mitral valve prolapse [True

[Tetralogy of Fallot [False

[Mitral Regurgitation [True

[Patent Ductus Arteriosus [False

Explanation

In hypertrophic obstructive cardiomyopathy, there is often mitral regurgitation caused by the abnormal interventricular septum septum.
There may be associated left ventricular outflow obstruction.
Giving nitrates will worsen the obstruction.
The risks are unpredictable - sudden death, slower progression to heart failure, or a relatively asymptomatic course may all occur.

The apex is the best place to hear a mitral valvular murmur.
As above, the apex is the best area to hear mitral murmurs

The murmur in Tetralogy of Fallot is usually pulmonary and best heard at the upper left sternal margin.

Now you know this. The mitral murmurs are best heard at the apex.

As in 3), the murmur of a PDA is best heard at the upper left sternal margin.
The signs of a PDA may include * unexplained apnoeas in a neonate;* full, easily palpable peripheral pulses (due to wide pulse pressure),* a systolic murmur ( rarely continuous ),* carbon dioxide retention, *increasing oxygen requirement,* cardiomegaly with * increased pulmonary vascular markings,* and hepatomegaly.
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