50 Cases in Clinical Cardiology: A Problem Solving Approach
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This book provides postgraduate trainees with 50 real clinical cardiology cases. Divided into fourteen sections, several cases are presented under each category covering various disorders of the cardiac system, including congenital heart diseases, aortic valve diseases, pulmonary diseases, ECG abnormalities, cardiac arrhythmias, coronary artery disease and much more. Beginning with a brief history and findings based on physical examination, each case then includes analytical discussion on bedside investigations and proposals for treatment. Authored by a recognised expert in the field, this practical book is highly illustrated with echocardiographic, radiographic and electrocardiographic data. Key points * Presents 50 real clinical cardiology cases * Covers numerous disorders of the cardiac system * Authored by recognised cardiologist * Includes more than 217 images, illustrations and tables
to aortic coarctation, is governed by the same principles that apply to the treatment of essential hypertension. This involves the judicious use of a combination of antihypertensive agents. Several drugs are used including diuretics, beta-blockers, calcium-antagonists and ACEinhibitors (or ARBs), since the hypertension is generally moderate to severe in grade and severity. Definitive treatment of aortic coarctation (systolic gradient > 30 mm Hg) is surgical excision of the area of aortic
left ventricular function was normal. In retrospect, there were several clinical pointers towards the diagnosis of pericardial effusion. A decline in pulse volume (fall in systolic BP>10 mm) during 114 Section 7 Pericardial Infections Figure 25.1: X-ray showing large cardiac silhouette with a narrow basal vascular pedicle inspiration, is known as pulsus paradoxus. Increase in venous return shifts the interventricular septum towards the left ventricle, thereby reducing stroke volume.
myxedema (hypothyroidism). PERTINENT INVESTIGATIONS Pertinent investigations in pericardial effusion are completed blood count, tuberculin test, antinuclear antibodies, renal function tests and thyroid profile. The pericardial fluid is tested by cytology, bacterial culture and for adenosine deaminase activity and tumour markers when tuberculosis or malignancy are suspected. MANAGEMENT ISSUES Drainage of a large pericardial effusion by means of echo-guided (for safe needle entry)
With the growing number of valve replacements, prosthetic valve endocarditis is on the rise. Finally, immunocompromised hosts such as HIV-infected patients and organ transplant recipients on immunosuppressive drugs are more likely to be infected by fungal organisms. C A S E 30 Tricuspid Valve Endocarditis CASE PRESENTATION A 32-year old male came to the out-patient department of a charitable hospital, with history of fever for the last 3 weeks. The fever was high-grade and associated with
of a portion of the ventricle, before the entire myocardium has been depolarized. There is an early uptake of the S-T segment, before the descending limb of the R wave has reached the baseline. This causes an initial slur on the S-T segment, known as the J wave. The S-T segment is elevated and concave upwards. There is an associated increased amplitude of the R wave. The T wave is also tall, but the ratio of S-T segment elevation to T wave height is less than 0.25. Interestingly, the degree of