Quiz #40: EKG

EKG from a 1-day old newborn is given. Patient was consulted by NICU for "bradycardia" (~90 bpm). Clue: V1 rhythm strip provides good wave form to evaluate.

Questions:
1) What is the cause of the relative "bradycardia"?
2) Explain why A-V block is not the primary diagnosis.

Link to the answer

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Quiz #39: Where is the catheter?

Two sets of images (PA & Lateral views in each) taken from the same angiogram - before and during contrast injection. This patient with tricuspid atresia is undergoing pre-Glenn catheterization.

Questions:
1) Trace the catheter course.
2) In which chamber is the catheter tip?
3) Comment on the great arteries relationship (normally-related or otherwise).
4) Based on answers to above questions, what classification type of tricuspid atresia is this?

Link to the answer

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Quiz #38: EKG: What is the rhythm diagnosis?

5-mo old with Down Syndrome. 2nd postoperative day after surgical closure of large inlet VSD.

Link to the answer

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Quiz #37: Video Quiz - Echocardiogram

Four-hours old newborn with cyanosis.
1) What do you observe?
2) Provide at least 3 differential diagnoses for this observation.

Link to the answer

Representative still image is below, just in case the video does not work.

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Quiz #36: EKG

12-lead EKG is provided. What is the diagnosis?

Link to answer

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Quiz #35: 12-Lead EKG

8 year old boy was referred for evaluation of chest pain. 12-lead EKG is provided. What is the EKG diagnosis?

Link to the answer

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Quiz #34: ICU - Temporary Pacemaker

Quiz # X: ICU – Temporary Pacemaker

6 month old infant s/p AV septal defect repair. 3^rd postoperative day. Underlying rhythm was 3^rd degree AV block & probable sinus node dysfunction. The rhythm strip was printed to evaluate the temporary pacemaker.

Questions:

1) What mode is being used?

2) Comment on the following:

a.       Is the pacemaker atrial pacing properly? (Yes/No)

b.      Is the pacemaker atrial sensing properly? (Yes/No)

c.       Is the pacemaker ventricular pacing properly? (Yes/No)

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Link to answer 

Quiz #33: ICU Arterial line traces

Quiz #33: ICU Arterial line Traces

13-year old patient who underwent repair of coarctation of aorta earlier that day has two arterial lines – right radial & left femoral. The apparent peak to peak pressure gradient across the coarctation repair site is 37 mmHg.

Question: Based on the traces in each arterial line, is the pressure gradient higher than, lower than or equal to 37 mmHg? Why?

Link to answer

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Quiz #31: RA line trace

This RA trace was recorded in cath lab, under endotracheal general anesthesia.

Question: Which wave is the taller one, a wave or v wave?

Link to the answer 

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Quiz #30: EKG - Arrhythmia

13-year old girl was transferred to Pediatric ICU for atrial flutter. She is obtunded and has muscle tremors. Suspected to have developed encephalopathy as part of a systemic vasculitis. Figure 1 is an strip from floor with EKG and pulse oximeter trace. Figure 2 is an apical 4-chamber view with Doppler trace of mitral/aortic valve flows.

Questions:
1) What is the diagnosis?
2) How will you manage?

Link to the answer

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Quiz #29: CT scan, Vascular Anomaly

Quiz 29: CT scan (Vascular Anomaly)

CT scan images from a 8-mo old boy with stridor, vomiting and weighs 5.6 kg. Figure 1 shows Anterior and Left lateral views. Figure 2 shows 3D reconstruction of trachea-bronchial tree (Barium swallow was not performed).

Questions:

1)      What is the arch sidedness?

2)      What is the diagnosis?

3)      Does the patient need intervention and why?

Link to answer

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Quiz #28: EKG

Quiz #28: EKG

3 year old, post-op day 1.

1)      What is the ventricular rate? (Note: Paper speed).

2)      What is the atrial rate?

3)      What is the diagnosis?

4)      In the past 4 hrs patient has become hypotensive with lower urine output and needed multiple fluid boluses and increase in Dopamine dose. What is the first line treatment?

Link to the answer

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Quiz #27: EKGs on the day of surgery

6 yr old boy, s/p Repair of subaortic membrane. Two EKGs with time of recording are given - both were recorded on the day of surgery. Second EKG was performed because bedside nurse noted a change in EKG trace on the monitor. Patient is sleeping without any complaints.

Questions:

1) Describe the most significant change between the two EKGs.

2) What are the possible reasons for change?
3) How would you proceed further?

Link to the answer

Click on the image to enlarge.

EKG 1: Recorded at 12:44 Hrs

EKG 2: Recorded at 22:44 Hrs. 

Quiz #25: Echo - Identify the vessel (again)!

Going with the same theme as Quiz #24.

Subcostal sagittal (bicaval) view in a newborn with severe cyanosis.

(Some labels are given. Clue: A vertical vessel flowing downwards, behind the IVC).

Question 1:

1)      Name the vessel shown by arrow.

2)      Provide a possible diagnosis. (I won’t be upset if you gave a second possible diagnosis as well!)

Link to the answer

Quiz #24: Echo: Identify the vessel

Subcostal saggital view from a newborn with multiple congenital heart defects.

Questions:

1)      Name the vessel shown by the arrow.

2)      What defect would you suspect from this observation?

Link to answer

Quiz #23: Shunt Calculation

Hypothetical case: 32 year old male with VSD and Eisenmenger syndrome. Necessary data are given.

Questions:

1)      What is the overall Qp/Qs?

2)      Calculate the effective pulmonary blood flow (Qep).

3)      Calculate the amount of right to left shunt.

4)      Calculate the amount of left to right shunting.

Link to the answer

Quiz #22: ICU monitor interpretation

5 month old baby. Postoperative day 1 after closure of membranous VSD. Panel 1 and Panel 2 were recorded few minutes apart.

Questions:

1)      What is the arrhythmia in Panel 1?

2)      What type of pacing is done in Panel 2?

3)      Describe the important difference between the CVP waveform in Panel 1 and Panel 2. What is the reason for the difference?

4)      Comment about AV conduction in Panel 2.

5)   Why does arterial line trace have a “flat top”? How will you rectify this issue?

Link to the answer



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Quiz #21: EKG

EKG (15-leads and Rhythm strip) is provided from a 11-yr old girl. Referred for sports clearance and family history of heart disease (Grand parents developed coronary artery disease in their 60s). Physical exam is normal.

Link to the answer

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