Quiz #37: Echo Quiz Answer

4-hr old baby with cyanosis. The following is part of the echocardiogram.

Questions:

1) What do you observe?

Answer: ASD/PFO with exclusive right to left shunting.

2) Provide at least 3 differential diagnoses for this observation.

Answer: (i) Persistent pulmonary hypertension of newborn (aka. Persistent fetal circulation), (ii) Tricuspid Atresia, (iii) TAPVR, (iv) Pulmonary Atresia with Intact ventricular septum, (v) Any condition with pulmonary hypertension in a newborn, e.g. Ebtein's anomaly with pulmonary hypertension, etc.

Quiz #36: EKG

Answer: Complete AV block

(Click on the image to enlarge)

Quiz #35: EKG - Answer

Question: 8-year old boy was referred for chest pain. What is the diagnosis?

Answer: WPW syndrome

Short PR interval and Delta wave are noted. Delta wave is somewhat atypical in appearance - as though it is a wide QRS complex. Nevertheless, it is Delta wave.

If you are interested in locating the accessory pathway, you may refer to the answer to Quiz #5. I think, it is left-sided pathway.

(Click on the image to enlarge)

Quiz #34 - 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: (Answers are in red-color fonts)

What mode is being used? ….DDD

Comment about Atrial pacing, Atrial sensing and Ventricular pacing?

a.       Is the pacemaker atrial pacing properly? (Yes/No) …No (No P wave after atrial pacing spikes “AP”)

b.      Is the pacemaker atrial sensing properly? (Yes/No) …Yes (When there is a native P wave, no atrial pacing spike. Atrial sensing “AS” properly)

c.       Is the pacemaker ventricular pacing properly? (Yes/No) …Yes (QRS complex follows every ventricular pacing spike “VP”)