EMQs in Clinical Medicine.pdf - Peshawar Medical College
EMQs in Clinical Medicine.pdf - Peshawar Medical College
EMQs in Clinical Medicine.pdf - Peshawar Medical College
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24 Cardiovascular medic<strong>in</strong>e<br />
Box 5 highlights some features of congenital heart defects that may appear <strong>in</strong> <strong>EMQs</strong>.<br />
Box 5 Congenital heart defects<br />
Symptoms/signs<br />
• Wide, fixed split second heart sound<br />
Ejection systolic murmur second, third<br />
<strong>in</strong>tercostal space<br />
• Harsh pansystolic murmur left sternal edge<br />
• Radiofemoral delay, hypertension<br />
• Cont<strong>in</strong>uous ‘mach<strong>in</strong>ery’ murmur below left<br />
clavicle<br />
• Cyanosis first day of life<br />
Chest radiograph: egg-shaped ventricles<br />
• Cyanosis first month of life<br />
Chest radiograph: boot-shaped heart<br />
Congenital heart defects<br />
Atrial septal defect<br />
Ventricular septal defect<br />
Coarctation of aorta<br />
Persistent ductus arteriosus<br />
Transposition great vessels<br />
Tetralogy of Fallot<br />
Box 6 summarizes some examples of causes of various ECG f<strong>in</strong>d<strong>in</strong>gs that may<br />
crop up <strong>in</strong> <strong>EMQs</strong>. An EMQ may require you to localize an <strong>in</strong>farct. Box 7 may<br />
help you to do this.<br />
Box 6 ECG f<strong>in</strong>d<strong>in</strong>gs [5, 6]<br />
ECG f<strong>in</strong>d<strong>in</strong>gs<br />
• ‘Saw-tooth’ pattern with<br />
normal complexes<br />
• Absent ‘p’ wave<br />
• Bifid ‘p’ wave<br />
• Peaked ‘p’ wave<br />
• ST depression<br />
• ST elevation<br />
• ‘Saddle’-shaped ST elevation<br />
• S I, Q III, T III pattern (deep<br />
S waves <strong>in</strong> I, Q waves <strong>in</strong> III,<br />
<strong>in</strong>verted T waves <strong>in</strong> III)<br />
• Tall tented ‘t’ waves, wide QRS<br />
complex (s<strong>in</strong>e wave)<br />
• Flattened ‘t’ waves, prom<strong>in</strong>ent<br />
‘U’ waves (muscle weakness,<br />
cramps, tetany)<br />
• Long ‘Q–T’ <strong>in</strong>terval, tetany,<br />
perioral paraesthesia,<br />
carpopedal spasm<br />
Condition<br />
Atrial flutter<br />
Atrial fibrillation<br />
S<strong>in</strong>oatrial block<br />
Left atrial hypertrophy, e.g. mitral stenosis<br />
Right atrial hypertrophy, e.g. pulmonary<br />
hypertension, tricuspid stenosis<br />
Myocardial ischaemia<br />
Acute myocardial <strong>in</strong>farction (MI)<br />
Left ventricular aneurysm<br />
Acute constrictive pericarditis<br />
Pulmonary embolus<br />
Hyperkalaemia<br />
Hypokalaemia<br />
Hypocalcaemia
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