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
- ß myosin gene defect
- Chr. 14
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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
- fast fall
- "Jerky pulse"
- Pulsus Bisferiens
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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
- A- Adriamycin = Cardioroxi
- B- Bleomycin
- V- Vinblastine/dan
- D- Dacarbazine
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dicrotic pulse
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twice beating pulse (Systolic + dystole)
- Alderence ? LVF
- Bigeminus ? V. Bigeminy.
- Anacrotic ? AS
- Bistinience ? HOCM (Jerky pulse".
- Collapsing ? AR
- Dicrotic ? D.C.M. (twice beating pulse)
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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
www.FirstRanker.com
(" (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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