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Download PG Medical 4th Year Medicine Notes

Download PG Medical ( Post Graduate Medical degree) 4th Year Medicine Notes

This post was last modified on 02 August 2021

NEET PG Last 15 Years 2012-2025 Previous Question Papers with Answers (Solved Question Papers)


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1. PULSE:

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S1 S2 S1

Slow rise initially, amplitude, dicrotic notch

Aortic valve = 2.5 cm2

Severe A-stenosis = <1 cm2

Ejection velocity > 4m/sec

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transvalvular gradient > 40mm

(Left ventricle - Aorta)

Super-severe = Ejection > 5 m/sec

TV gradient > 55mm.

Slow rise (Pulsus tardus et PARVUS)

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amplitude

4 dicrotic notch (Anacrotic Pulse)


2. HOCM:

  • AD
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  • ß myosin gene defect
  • Chr. 14

1) Asymmetrical Septal Hypertrophy

2) LV outflow tract Obstruction (LVOTO)

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3) Diastolic dysfunction Systolic dysfunction.

Collapsing pulse

Radial

HOCM

  • fast rise
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  • fast fall
  • "Jerky pulse"
  • Pulsus Bisferiens

Character Carotid


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3 Water Hammer pulse/ Corrigan's / collapsing pulse :.

  • Radial Character.
  • Aortic Regurgitation

3 Dilated Cardiomyopathy (DCM): Globular.

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  • Alcohol toxin
  • Sequalae of viral myocarditis
  • Coxsackie B
  • m.c. non-infectivee sarcoidosis.
  • Chemotherapy in Hodgkin lymphoma ? ABVD
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  • A- Adriamycin = Cardioroxi
  • B- Bleomycin
  • V- Vinblastine/dan
  • D- Dacarbazine

dicrotic pulse

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twice beating pulse (Systolic + dystole)

  • Alderence ? LVF
  • Bigeminus ? V. Bigeminy.
  • Anacrotic ? AS
  • Bistinience ? HOCM (Jerky pulse".
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  • Collapsing ? AR
  • Dicrotic ? D.C.M. (twice beating pulse)

P. Alterans

viral myocarditis

LVF Dand wall MI = LAD

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wet ber Beri = thiamine ?

S. Arenda


Digoxin toxicity

DOC = lignocaine / Phenytoin

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m.c. Asakythonks - Ventricular Bigeminy.

P. Bigemineus

puke

weakpute

pale

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Premature ventricular

Contraction

weak puke

digoxin toxicity Doo - digibond

? IS! Jina. Mx E1 KCI Correction (i.v.)

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Ma conection (Mg804) (im)

digiband

Hemodailysts (not done)

Gb/c digoxin = 11 Vd (volume dishibut")

11 Protein bourding.

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Acle CHF:

Ist earliest symptoms

diaphoresis (1)

2- Palpitations

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3- Pink frothy sputum

4- Dysprea grade. III

5 - dizziness / vertigo / syncope

tachycardia (earliest sign)

LVF

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RVF

SBP

oliguria

pulmonary edema

B/L fine Crepitations

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Bi-Basiliar Crept = ILO

S3: Ventricular gallop

erythin

(lowpitch sound: BELL)

B/L mpha-axillary Breat's

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sound

Meniscus sign

(Pl. effusion B/L

C.P. angle Blenting

Hydropneumothora

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Cipangle blunt


house Carold frequency

- Loop inspiration IVP falls

RVFpt + days inspiration Ive sise

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(compliance)

Abdomino-Jugedar Refler.

-JVP palickle

Kussmaul sign

8- Tender Hepatomegaly

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Indicak RVF

U sudden sheshiy of capsule of liver

Fulbatile Len = TR (bricuspid Requngitation)

Systalic pulvation Lives - TR.

pre-syskalic

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-TS

FRAMINGHAM CRITERIA - feature of acute CHF

miner crikva

majer criteria

? Tender Hepatomegaly

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? JVP

? ?s?

2. Be creptim (fine)

?liguria

Pardal edema

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I feature of chronic CHF


investigation: (Acute CHF)

?- BNP level ?

B-type natristic peptide ?

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verniche volums Quartanding

? ?

SBPGFR RAAS aldosterong ?

40 = ENOC

@MJabolic Alkaloi

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Clust

END ENC

Salt + 120

? winary sodium: lous

? CXR

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& earliest Radiologied sign of pulmonary adsma

Prominent upper lobe veshe (cophatica

CT Ratio ? 05

PCWP1 = 8-12mmHg).

4 dus to trans udoblen

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- Bat using pulmonary edsna

Cardiac indes not en klo

- Silhaut sign

Kerley B live

freen 1 to pleurd surface).

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outer tandan

CHF

@aumpangiomakris

Corono matacis


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? only pick up systolic dystonkion=

IOC for CHF = Echocardiography

9) Systolic dysfunction

= EF = SV-65%

EOV

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EF<65%

b) diastalic dysfunction = SV

?

EDV

(Compliance 1)

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Pulmonary edema EF >/

(Praling of blood in)

Jung

Ejection Fraction method calculation: (EF) = Volume 3D concept

? Thermodilution

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2 Echo

? MU.G.A scan

? Cardiac MRI :

Candiac MRT (baest.)

multiple uptake gated

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acquistion scan = te 99

R: Acute CHF

? Reverse. Tredelenbung position

? QC Rebreathing Mark >60%

? iv. Furosemide 20mg

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?iv Morphine a) (Pulmonary edema reduction).

causes jounting of blood from pulmonary

systolic system)

(3mg iv. / 10 mg im. / 13 mg Sc.).

? sympatholytic

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(? infract size)

© Air-Hunger

Pain


? NTG dúp

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Dohwamine B-HR

Dopamine

1- Rug/kg/min D, AGIR

2-10 µg/kg/min B

>10 1g/kg/min a, a, ve-BP.

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norepinephrine

14 OBP ? cononary flow

Acade Chicomran

L- Jasix

M. Monplore

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N- Nilnates

0-02

P. Positioning

?

SpO2 -80%

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Crepilabs +++

& Cardiogenic Shock

G

?@ Norepinephrine (best day

(DBP-70-10

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? add dopamine

SBP- leommkg)

? dobutamine

(Only given which SBPg

?

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sp O: 70%

Crepitation - +++

?

NESIRITIDE = nahiuresis

MILRINONE ino-dilalar

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(?power, load)

?

? central cyanosis ++

? Left ventricle curist device (LVAD)

[HEART-MATE TM]

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no role of Digoxin Acute CHF

?Nalk pump

? Cat²- inotropic ?

+2

? Os consumption

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(2 vaqur stimulation

HR O2 consumphon

Hoeker CI in qeute CHF

+ pereffered agents = Mx chronic compensatory CHF

mortality reducing drug in chor CHE

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(metoprolol

Bisoprolol

Carvedilol

Carvedilol> metoprolol

Chis CHF @ventricular remodelling.

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ACE E

B-blocker = O consumption?

Pedal edema Ascih's / Perionbidal edema

-Spironolactone (s/c qyrecomastia)

edemain

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-eplerenone (nos/6)

Cho CHF

Acve CHFILMNOP

Cordieagente, shock - Only shock CVP ?

NE+ dopamine + dobutamine

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Chronic CHF B.blocker = Doe

2

- ACCO

@pedal edema

Ascitis

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perionbizal edema.

- diuretics (uptill edema)


ECG

R

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P

T

S

U delay Repolarisation of papillary muscle

T Repolarization

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9 septal activation

9.RS ventricular depolarization-

Atrial depolarization

P-Rinky A-V nodal conduction

S-T segment iso-elechic segment

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Cardiac Action potential

2

0

phare 2 ST segmen

Phare O + 9,RS

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phare 1 9RS

Phare 3 Twave

SAnode potential = -55mV

fining potenial SA node If- funny Current

Awomaticity decided by

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60-100 bpm


(60-100bpm)

SAnde

Bachinann Bundle

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RIANO

Wedne.bach

bunde

(45-60bpmunode

AV nodal delay

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? (?

Punkinje fibne (trotopin)

R

(15-20bpm)-

T

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depolarisation PRS endo - epi

Repolarisation= T = epi- endocardial.

isolated Cardiac issue."

?

depolanization = epi - endo.

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Repolanization = endo - epi

Common crea

RAD

P wave-

LAD

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40msec

Pwave

Pwave 120 msec. - 3 small square

Pwave (41)= <2.5mm = limb lead

<1.5mm = Chest lead.

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? MS: LA

(+)

>120msec

IP-minale


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?MS = LA enlarge

PA Hypertension

RVH: RA Overloading

P-Pulmonale = lang standing M.S.

>2.5mm limb lead

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I af of had it

P- wave always

= upright <120 msec

GVR =

V=

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RAD = Ove

= biphasic

(2) PR interval

Ist degree Heart

Block

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Hill q.wave

?PR-

Oilsee

Athlethes (Manakion)

Anode

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Avnode

Aschoff nodle - Rheumas

Sarcoidosis: granuloma A

Hemochromatosis

endomyocardial

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fibroblastosis (somia)

(idiopanic)

PR 1

HR

PR

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B

C

(N) PR = 120-200m sec

(3-5 small sq.)


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PR-160 msec

Situp: HR?

PR = 140msec

I'st degure block = effort intolerance

? ECG = P-R = 200 msec

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Connection

Problem

not pacemaker

R= Quad Atropine

(after exercise no charger of PR)

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(ans cholinergic drug)

defect

HR

PR

SA node ? Sick sinus syndrome 45-60bpm ?

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AV node Complete block <40bpm

? ? Mobitz? block <15-20bpm

-m.c. bradyarythmia Cousing sudden Cardiac death post MI

G Mobiz II H.Block

- m.c. tachyarythmia SCO post MI

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(m.c. arythonia

alten MI)

(¿Levine sign)

? vennicular fibrillation

"<149 (golden period)

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2 2º degree block

@ Mobitz I/Weckrebach phenomenon = proble instele the AV node

SAnode-

AVnode / Slo

A

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B

X C

PR

PRIIT - missed beat = PR pi?

Slow

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Conduchon


140?

180?2

200m

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assymmetrical Printerual before & after

missed beal

- dizzines

mjesed

seat

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vertigo

Synebpe

Mobid 2 II

SAnode

?AVnode"

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A

B

C

PR

defeet in BOH

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-no change in PR interval

200

:

missed beat

aber

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-Symmetrical PR before 2 aften missed beat

- lethal Arrythmia (anteroseptal myocardial infraction)

-

Pacemaker (Temporary pacemaker insertion = best /t)

3rg degree block

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Corduction

SA node

?

?alnial Rate = 100 bpm

AVnode

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?

AV dissociation Ant low Cardiac omput

? ventricular Rate = 40 bpm

Season

? Bradycardia

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(complete

dariage ?

BON

? AV dissociah'?

Symptoms

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Onstand up positionchay

GUR, no charge

-Syncope/vertigo

dizzines

(Hollet seat uue koutek 201

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Rheumatoid Artmitis improve during pregnancy. (exception)

On ECG

and degne.

?

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PP

RR-

Nph

P

P

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PP

-RR

N PP=RRinksual.

3nd degne block

? absence of N Sinus rhijthom.

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2. P-Pinterval = unequal

7/1 of choice = Dual Pace

I

SAnode Avnode

effort intolerance

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PRO

Symp: PR

Re: oral Ahopire

2

MI:weekhebach

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PR 111 missed beat-111

MRdizzthers W

MII

PR missed beat : PR

BOH #

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3

SLE-autoimmun

Ro Ab IgG

inansplacental sprood

yehis Sanode obr

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Avmode

BOM<4067

even

destroy before bom

of baby!

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?

A neonate MR=120 bpm.

SLE tehes

?

Apgar scare ?

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delivery


Baby bom from SLE motkey:

HR = 40 bpm

maro Reflex : ?/sluggish

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K19

neoratal

lupus

Caused by Lo Artbo

Apgar score = low:

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On ECG- P-P J, unequal

repnatal lupus

R-R

Rx: Dual Pacing (on Ist day of life)

? Ro - IgG, (Cross placenta)

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-

(2) Butterly Rash

?HRO: ECG

L

?

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SAnode

(AVhode)

BOM

?

PF

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Wolf Parkinson white syndro

conduchien. 1 accessory pathway

? Pre - excitation synchome

Bundle of Kert

(3) 20-40 assymplo?

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Palpitations

Syncope on exercise

Sudden cardiac dea

in sibling (? ?

Conduction HR ? = diastole duration ?

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EDV

SV

COJ

4 ECG:

9) Short PR interval (tasconde

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b) wide QRS compter


? & RS complex = 80-100 msec - 2 small square

wide QRI = WPW syndrome

(idermyocyk

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20 20yr

PR

GRS

PJ = PR + QRS Constant.

Short kit broad

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Intermyocyte

Conduch

j.e. InwPw synchon

PJivesual geneticall

Consten't acquired

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ds

Pilot

asymplomalle

medical fitness-

ECG = PR <120 msec

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<3 small square

della wave

>qRS: 2 small square

PJ = N

?

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UNFIT

Rx oral flecainide = DOC

Radio frequency Ablation = TOC


Byrds. SAN

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(AVN)

Pre-excitation Syndrome.

? WPW Syndrome

Kent's Bundle

PR

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della wave A

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(" (Sean in upslope of R wave)

GRS complex wide.

PJ interval (N

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DOC mal plecainide

TOC RFA

SCO

? MIV fibrillation Mobita black

? HOCM-Atheletes/Football?

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(18) WPW syndrome HRT EDUJH COL

(4) LGL syndrome

Soum Avian

meie of sudden nochinal dean = males.

5) BRUGADO Syndrome is Sexdium channet defect sudden cardin dest

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MRIT Kelative 012 for = Pacemaker pr.

Bradycarrythmia: Pacemaker required

? sick-sinus syndrome = 40-60 bpm SAnode #

2 Complete H. Block = <40 bpm ? AVnode #

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? Mobite. II H. Block = 15-20 bpm ? BON #

(temporary pacemaker insertion)

Ist degree H. block = oral almopine

I's degree i block in Athlete = may be N no Hr.

site the pacemakes = left side infraclavicular area below the

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skin of chest (Computer.....

having titanium coating

Battery life-5-7 yrs

? leads (Radio-opaque)

Grouch Leffe Abo

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Right ventricle (not Rt Atria)

Single lead pacemaker = RV

double lead pacemaker = RA-RV

- triple lead pacemaker = RA RV LV

(Superior)

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Read ECG

Analyse ECG

arrythmia detect

DC Shock give.

implantable Cardibuenas defibrillator (ICD) = yon tachyanthmia på.

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Site = where tachyarnyshinias

? DEM ? alchohol ? Long QT syndrome (parddanic.condi

? ROM ? Romano-ward sindrome (AD inheritare)

? LV aneurysm MI

? Brugade Syndrome i'S

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Holiday Heart Syndrome

? Bunge drinking - Dem

Atrial fibrillation.

SCO

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+/ = ICD

? RCM? Amyloidosis

? HOCM AD, Chr.

?MT

Tmaue

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MI Ist sign Ech is tall Twave (Hyperacute Tuwave)

?

Tilave inversion

MI

valerinable

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Period


phase 2 ST segmen

Phare O + 9,RS

phare 1 9RS

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Phare 3 Twave

SAnode potential = -55mV

fining potenial SA node If- funny Current

Awomaticity decided by

60-100 bpm

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