 |
|
|
||||||||||||||||||||
|
||||||||||||||||||||||
|
Crossword Puzzles: |
||||||||||||||||||||||
|
|
 |
|
|
 |
|
|
|
A 29 year old Asian male presents with fever and a productive cough. Auscultation reveals bronchial breathing at the left base and widespread crackles. A chest x-ray confirms left lower lobe pneumonia and in addition shows bilateral fluffy perihilar shadowing, Kerly B lines, and upper lobe venous distension. What does the EKG show and what is the diagnosis?
Rate: 90 Rhythm: sinus rhythm Axis: normal P: bifid in II; inverted in V1, V2, and III; biphasic in V3 PR: normal QRS: R in V1 ST: normal EKG diagnosis: Sinus rhythm and left atrial hypertrophy Clinical diagnosis: Lobar pneumonia Pulmonary edema Mitral stenosis Practice Points: -The diagnosis in this case is severe mitral stenosis with pulmonary edema precipitated by an intercurrent infection. -Mitral stenosis leads to left atrial hypertrophy and dilatation, pulmonary venous hypertension and consequent right ventricular hypertrophy, then failure.
Practice Points: -The EKG features of mitral stenosis are due to the effects of chamber hypertrophy and can be partially masked by the onset of atrial fibrillation. -The cardinal features of left atrial hypertrophy are: -notched p-wave exceeding 0.12 seconds in duration -P wave in V1 is predominantly negative. It is either entirely negative or biphasic with a larger negative component. -In this case, the P wave is entirely negative in V1 and bifid in lead II. -The cardinal features of right ventricular hypertrophy are: -QRS axis more positive than + 90 -Dominant R wave in V1 with QRS duration less than 0.12 seconds -S wave in lead I -In this case there is no EKG evidence of right ventricular hypertrophy |