EKG, Echo, Cath

Question 1

Describe the findings

Answer 1

• NSR ( +1 )
• ST and/or T wave abnormalities suggesting electrolyte disturbances ( +1 )
• Prolonged QT ( +2 )
• Hypocalcemia ( +4 )
  
  • ​prolonged QT = long ST segment + normal duration T wave
  • characteristic of LQT-3 subtype
  • Ical = 2.7 in this patient

Question 2

Describe the findings

Answer 2

• NSR ( +1 )
• Dual-chamber pacemaker (DDD), normal functioning ( +2 )
• Bi-V pacing / cardiac resynchronization ( +4 )
  
  • ​RA lead is appropriately sensing the underlying SR and therefore triggering the RV lead to fire
  • dual V-pacing spkes occurring just after each other (best seen in V2)
  • upright (RBBB morphology) QRS complex in V1 –> suggests Bi-V

Question 3

Describe the findings

Answer 3

• NSR ( +1 )
• AV block, 1st degree ( +1 )
  
  • subtle P-waves with prolonged PR in V2-V4 –> NSR with 1st degree AV block
• IVCD, nonspecific ( +1 )
• ST and/or T wave abnormalities suggesting electrolyte disturbances ( +2 )
• Hyperkalemia ( +4 )
  
  • ​K = 9.2; marked QRS widening

Question 4

Describe the findings

Answer 4

• SB ( +1 )
• Borderline normal EKG or normal variant ( +1 )
• Normal variant, early repolarization ( +4 )

Question 5

Describe the findings:

Answer 5

RCA dissection

• mid-RCA:
  
  • small, linear cleft indicative of a vessel dissection
• IVUS confirmed dissection

Question 6

Describe the findings:

Answer 6

• MR ( +4 )
• LV aneurysm ( +2 )
• MV, systolic anterior motion ( +1 )

*****Dx: HCM with prior apical MI –> LV apical aneurysm

******mid-cavity obliteration during systole –> LVOTO

*******mechanism of MR in this setting –> systolic anterior motion of anterior MV

Question 7

Describe the findings

Answer 7

• RV
• Pulmonary valve stenosis ( +4 )
  
  • ​post-stenotic dilation of the pulmonary artery on RV gram will confirm the diagnosis

Question 8

Describe the findings

Answer 8

• Severe MS ( +6 )
• Rheumatic mitral valve disease ( +2 )
• LAE ( +1 )

Question 9

Describe the findings

Answer 9

• Aortic dissection, Type A ( +6 )
• Aortic enlargement or aneurysm ( +2 )
• Mild-moderate AR ( +1 )
• Mild-moderate MR ( +1 )

Question 10

Describe the findings

Answer 10

• Atrial myxoma ( +6 )
• Mild-moderate MS ( +2 )

Question 11

Describe the findings

Answer 11

• RCA fistula ( +4 )
  
  • ​SA node coming off proximal RCA –> large atrial myxoma
• Severe RCA stenosis ( > 75%) ( +4 )

Question 12

Describe the findings:

Answer 12

• Coarctation of Aorta ( +4 )
  
  • ​known history of coarctation
  • underwent surgery at age of 10
  • follow up revealed 25 mmHg residual pressure gradient across the coarctation
• Aortic aneurysm ( +4 )

Question 13

Describe the findings

Answer 13

• NSR ( +1 )
• LAE ( +1 )
• RAD ( +1 )
• IVCD, nonspecific type ( +2 )
  
  • criteria for LBBB are not met due to lack of slurred R-waves in the lateral limb leads
• PPM malfunction - failure to capture ( +4 )
• PPM malfunction - failure to sense ( +4 )
  
  • ​atrial pacing exists, but there is a failure of the atrial spikes to capture (spikes without any evidence of conduction)
  • atrial spike seen just after the second QRS complex of the tracing that is clearly occuring too son after the previous P-wave ( < 240 ms) –> atrial lead is failing to appropriately sense the intrinsic P-wave

Question 14

Describe the findings

Answer 14

• VT ( +4 )

Question 15

Describe the findings

Answer 15

• Membranous VSD ( +6 )
  
  • ​perimembranous VSD near the LVOT
  • patient with history of Down Syndrome (Trisomy 21)
  • presented with a murmur and was found to have a small, hemodynamically insignificant VSD

Question 16

Describe the findings:

Answer 16

• Anomalous LCx ( +4 )
  
  • ​benign anomaly, LCx will always course posterior to the aorta and never between the great vessels

Question 17

Describe the findings

Answer 17

• NSR ( +1 )
• LAD ( +1 )
• LVH ( +4 )
• ST and/or T wave abnormalities ( +1 )
• HCM ( +4 )

Question 18

Describe the findings

Answer 18

• Atrial flutter ( +4 )
• Nonspecific ST and/or T wave abnormalities ( +1 )

Question 19

Describe the findings

Answer 19

• NSR ( +1 )
• LAE ( +1 )
• 2nd degree AV block, Mobitz II ( +4 )
• Nonspecific ST and/or T wave abnormalities ( +1 )

Question 20

Describe the findings

Answer 20

• A-fib ( +1 )
• AV junctional rhythm/tachycardia ( +1 )
• 3rd degree AV block ( +1 )
• Anterior or anteroseptal, age indeterminant or probably old ( +1 )
• Prominent U waves ( +1 )
• Digitalis toxicity ( +4 )

Question 21

Describe the findings

Answer 21

• Mitral valve prolapse
• Normal
  
  • LV size
  • Wall thickness

Question 22

Describe the findings of M mode:

Answer 22

• E - early opening
• F - floating closed mid-diastole
• A - atrial opening
• C - closure
• D - end diastole, just before MV opens

Question 23

Describe the findings:

Answer 23

• SAM
• Hypertrophic cardiomyopathy
• Asymmetric septal hypertrophy

Question 24

Describe the findings

Answer 24

• Asymmetric septal hypertrophy
• HCM
• Normal to hyperdynamic LV function (EF > 50%)
• SAM
• Mild-moderate MR

Question 25

Describe the findings

Answer 25

• Rheumatic
• Severe MS

Question 26

Describe the findings:

• 28-year old male with A-fib and Edema

Answer 26

• Ebstein’s Anomaly
• Tricuspid Valve:
  
  • fails to coapt
  • severe TR
• RV function
  
  • enlarged RV
  • global hypokinesis
• Atria
  
  • enlarged RA

Question 27

Describe the findings:

Answer 27

Muscular VSD

Question 28

Describe the findings:

Answer 28

Supracristal (Outlet) VSD

Question 29

Describe the findings:

Answer 29

Question 30

What is the differential?

How can you differentiate?

Answer 30

• VSD
  
  • Membranous
  • Supracristal (Outflow)
• Short Axis
  
  • Membranous →
    
    • 10 oclock
    • TV
  • Supracristal (Outlet)
    
    • 2 oclock
    • PV

Question 31

Describe the findings:

Answer 31

• “Complete AV Canal Defect”
  
  • Primum ASD
  • Membranous VSD
• Enlarged RV
• Enlarged LA, RA
• Severe MR
• Severe TR

Question 32

Describe the findings

Answer 32

• Apical HCM
• Normal/Hyperdynamic EF

Question 33

Differentiate - Thickened Apex

Answer 33

• Apical HCM
  
  • contrast fills apex
• HES / Loefflers’
  
  • clot filled apex (contrast does not fill)