زكاة العلم الدكتور محمد البيضاني

60 years old with history of palpitations Present with attack of tachycardia ECG show - regular - No P wave - narrow QRS This is SVT I did modified valsalva manoeuvre and the rhythm regain but unfortunately I didn’t take Video. Modified valsalva manoeuvre done by - keep patient in sitting position with extended legs - ask patient to take deep breaths and then breathe out though closed mouth and nouse or against syringe or bottle and number 15 second - after that lye the patient and elevate his legs about 90 degrees Do this manoeuvre with cardiac monitor.

60 years old male with history of IHD presented with chest pain?. ECG show - ST elevation lead I, avL and V2 - reciprocal ST depression in inferior leads mainly lead III. This called high lateral MI due to occlusion in the first diagonal branch D1 of left anterior descending coronary artery. Criteria - ST elevation in lead I, avL and V2 - reciprocal ST depression in inferior lead mainly III. This called South Africa 🇿🇦 flag sign.

Beta blocker in heart failure Only - bisoprolol - metoprolol *succinate* - carvidilol Should be started at very low dose and titrated up with 1–2 weeks and target of heart rate about 55-60 bpm. @ Avoid starting in acute pulmonary oedema @ after starting the feature of heart failure increase don’t stop the treatment with the time the symptoms improve.

46 years old female presented with SOB , sweating and paler. During examination there was dyspnea , tachycardia, good air entry bilateral and huger for breath. Vital show low SPO2, hypotension and tachycardia. She did liposuction operation before 2 days. ECG show - sinus tachycardia - S1Q3T3 - poor progression of R wave in pericardial leads - persistent deep S in V6. D dimer elevated Echo study show right side over load with pulmonary pressure 65 mmHG. Patient unfortunately passed. This is pulmonary embolism.

27 years old healthy,wealthy with negative past medical his of IHD or chronic disease. he on regular exercise In the Gym and taking what’s is called Protein, creatine and power. He complaining from frequent attacks of tachycardia and recently had chest pain in the exercise which prevent him from completing the training. Now he develop chest pain during sleep that wake him with slight anxiety Manx tachycardia. What’s your idea of the case. And the patient non cooperative to do ECG. He complete the sleep with but write the case before that ?.

56 years old female with history of IHD,HF and hypertension presented with palpitations and hypotension ? ECG show ventricular tachycardia which is unstable treated by 100 J synchronised DC . ECG after shock reveal sinus rhythm with ventricular ectopic beats which is the focus that form the VT.

54 years old male with DM, smoking and positive family history of IHD. Presented with sever chest pain and positive S troponine. ECG show - irregular, narrow QRS and no P wave >>> atrial fibrillation - widespread ST depression and ST elevation in avR - there is three differential diagnosis ( triple vessel disease, proximal LAD and left a main stem occlusion). His brother had CABG , make triple vessel disease at the top of differential diagnosis Echo study show mild LV dysfunction Treatment - aspirin 300 - plavix 300 - heparin 5,000 IU IV - atrovastatin 80 mg - ACE inhibitors or ARBS - GTN - beta blocker like bisoprolol - small dose of diuretic - heparin infusion (25,000 IU ) Then the patient need angiography and the other related to cardiologist.

Sinus rhythm with supranational ( atrial ectopic beat bigmeni) Criteria of supranational ectopic beats - come early - preceded by abnormal P wave morphology or absent P wave - same shape of sinus beats as the ectopic beat above the AV node and pass through the AV node and take the same shape of sinus beat - post ectopic wide distance

Sinus rhythm with supranational ( atrial ectopic beat bigmeni) Criteria of supranational ectopic beats - come early - preceded by abnormal P wave morphology or absent P wave - same shape of sinus beats as the ectopic beat above the AV node and pass through the AV node and take the same shape of sinus beat - post ectopic wide distance

تحيه خاصه عائلتي الكريمه ودي اقدم كم نصيحه على الماشي ١- دائما احترم كل المستويات العلميه ولا استهزء بس معلومه تنحجي او اي نصيحه سواء من الاطباء او الاستاف(اني مره شخص MI عن طريق معين الطوارء ) ٢- دائما لاتخلق اعداء الك بالعمل ، وخلي وجهك مقبول من كل الاطراف ولا تتصدء لايشياء ممكن يكون الخاسر الوحيد بيه المريض وحركات الكلب ٣- لاتضوج اذا شفت احد يفتهم او عنده معلومه وحاول تتعلم منه اي شي وحسسه بهل شي انطيه قدره ومكانته حتى هوه ما يبخل عليك ويحس يحجيه لشخص يستاهل ٤- دائما خليك بناء وطموح الله انساك قابليه وسخرك بمكان عضيم جدا خلي صقف طموحك عالي حيل لان ماكو شي صعب ٥- لاتبخل بمعلومه ، بشرح موضوع ، بنصيحه ، انقل تجاربك الزينه والموزينه للاخرين ترا اي مريض يتعالج على معلومتك الله يثيبك وممكن موقف منك لشخص يصنع منه طبيب ناجح ٦- مرات تتعامل وي شخص هوه قانونيا اعلى منك مرتبه واقل منك علميا لاتحسسه بهل شي وخلي تعاملك وياه ك فريق عمل وقدم نصيحه بدون متحسسه باغلاطه وهل اشياء اكو عباره تعلمته من شخص مستواه بسيط كنت اشتغل ايكو بدايه تدريبي عليه كال د محمد the eye can’t see if the brain don’t know كان الها دور جبير بتعلمي الايكو خلتني اعبي الدماغ معلومات وادرب عيني طبعا هوه المثل يطبق على هواي شغلات

Moderate mitral stenosis due to rheumatic fever. Echo finding - fusion of mitral valve cumissure - domino g of anterior mitral valve leaflet which take shape of hockey 🏑 stick appearance - mild dilation of left atrial ECG : normal Treatment - beta block - diuretic ( as the left atrial pressure increases >> increase in the pulmonary vessels pressure >> pulmonary congestion >> pulmonary odema - aspirin to decrease the thrombus formation due to stasis of blood Serial follow up.

-Reciprocal ST depression of lateral MI in the inferior lead lateral mainly III, so anteriolateral MI had this reciprocal change and vices versus - anteriosptal MI has reciprocal change in posterior lead vices versus

Sometimes when you receive like this ECG You will shocked and don’t know the head from the toes by as simple - is it regular ? , No it is irregular but P wave present so this is not AF - is the ECG narrow QRS or wide ? It is wide QRS and had different morphology Those with P wave take shape of LBBB ( deep S in V 1 and rS in V6 or M shape with T wave inversion in lead Iand avL) , while those that not preceded by P wave was also wide , different morphology from the preceding beat with wide distance after these beats so this is ventricular ectopic beats). Not the supranodal ectopic beats pass from the AV not and take the shape of preceding beats so if the normal beats has bundle block the ectopic beats will take the same block. -read the ST and T wave changes in normal beats not in ectopic beats ( which occur unfortunately by resident doctor and manage the case as ischemia and so on - try to search for the causes of ectopic beats like Ischmic, electrolytes, myopathy, drug like digoxin toxicity and so on

45 years old female presented with sudden onset of SOB. He had negative history of IHD,no structural heart disease, no history of fever, no history of pregnancy and so on. He just had tenderness in the right legs Spo2 :92% HR:140 bpm BP:100:65 mmHg ECG show - sinus tachycardia - slightly right axis deviation ( negative R in avL and positive in lead II) - slightly S1Q3 and flat T wave in lead III - partial RBBB - persistent deep S in V6 All of these are strains pattern over the right side Echo study show - dilation Right side - slightly fluttering in the intraventricular septa - D shape in the left ventricular in the short axis - tricuspid regurgitation with pulmonary pressure about 49mmHg. Pressure overload. D dimer elevated CT angiography show pulmonary embolism Patient take actilyase (200 mg over 2 hour) there is improvement - decreased the dyspnea - decreased the heart rate to 105 bpm - improved BP - also echo study show decrease the pressure overload over the right side ونسالكم الدعاء

45 years old female presented with sudden onset of SOB. He had negative history of IHD,no structural heart disease, no history of fever, no history of pregnancy and so on. He just had tenderness in the right legs Spo2 :92% HR:140 bpm BP:100:65 mmHg ECG show - sinus tachycardia - slightly right axis deviation ( negative R in avL and positive in lead II) - slightly S1Q3 and flat T wave in lead III - partial RBBB - persistent deep S in V6 All of these are strains pattern over the right side Echo study show - dilation Right side - slightly fluttering in the intraventricular septa - D shape in the left ventricular in the short axis - tricuspid regurgitation with pulmonary pressure about 49mmHg. Pressure overload. D dimer elevated CT angiography show pulmonary embolism Patient take actilyase (200 mg over 2 hour) there is improvement - decreased the dyspnea - decreased the heart rate to 105 bpm - improved BP - also echo study show decrease the pressure overload over the right side ونسالكم الدعاء

As simple as that there is - widespread ST depression - fattening of T wave - prolongation of QT interval - u wave appear in some lead but not clearly Clinically weakness in the upper and lower limbs Lab study sever hypokalemia

احبتي الكرام اكو عباره تكول الملائكه في العناوين والشياطين في التفاصيل ههههه. انت ك مقيم دوري و احيانا ك مقيم اقدم مو لازم دائما تعرف تفاصيل دقيقه او من اشوف اشخاص يحجون بتفاصيل تحس نفس ما فاهم شي يكفي في بعض الكيسات تعرف انو هذا مثلا يبقى مراقبه ، هذا يحتاج استشاره، هذا لازم يراجع اخصائي بهل اختصاص وهكذا. اتذكر كان مقيم وياي يلزم طوارء هوه جاب الكليه لو تحميل لو يعيد لو دور ثاني بس كلش أحب الخفاره وياه لان يشتغل بالجهد الي يكدرله والمعلومه والكيس الي ميعرفله كبل يستشير ويسال ويحسسك هوه مايفهم ويريد يتعلم منك وطبعا هوه يادي افضل من الاوائل لان يستلم الكيسات كله وميخاف ولا يغلس او يسوي روحه ملتهي من يجي كيس تعبان حتى ما يشوفه المهم كان عنده عباره تكول( اني ما اعرف شنو حاله المريض بس اعرف انو خطره ولازم يبقى متابعه وميطلع ولازم الاقدم يشوفه) رباط السالف على الكيس الفوك هوه - has risk factors for IHD - come with chest pain - there is st and T wave change not preceded by Q wave . يعني هل حاله اكو اسكيما بالموضوع اذا مو طارئه وتحتاج تداخل لازم يراجع قلبيه ويرتب وضعه🙂.

55 years old male with HTN and smoking had frequent attacks of chest pain. What do you think about the ECG?