Quiz 4:

This 45 year old man, comes with history of Dyspnoea on Exertion since 3 years, rapidly progressing since 1 month to Dyspnoea at rest since last 2 days. History of Orthopnoea and Paroxysmal Nocturnal Dyspnoea present.

On Examination, following signs were present as shown in pictures above.

CVS Examination-

BP in both upper limbs: 110/30mm Hg, and in both lower limbs 160/40mmHg (Hill’s sign Positive)

A short systolic murmur and an early diastolic murmur heard.

Diagnose the condition…..

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WHO Pandemic Levels

Here is a quick look at the WHO's pandemic alert phases:

• Phase 1: A virus in animals has caused no known infections in humans.
• Phase 2: An animal flu virus has caused infection in humans.
• Phase 3: Sporadic cases or small clusters of disease occur in humans. Human-to-human transmission, if any, is insufficient to cause community-level outbreaks.
• Phase 4: The risk for a pandemic is greatly increased but not certain. The disease-causing virus is able to cause community-level outbreaks.
• Phase 5: Still not a pandemic, but spread of disease between humans is occurring in more than one country of one WHO region.
• Phase 6: This is the pandemic level. Community-level outbreaks are in at least one additional country in a different WHO region from phase 5. A global pandemic is under way.

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Normal Chest Xray

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Answer to Quiz 3:

Ans: Supra-ventricular Tachycardia with Aberrant conduction.

Explanation:

Four Brugada Criteria for Diagnosis of Ventricular Tachycardia:

1. Lack of an RS complex in the precordial leads

2. Whether the longest interval in any precordial lead from the beginning of the R wave to the deepest part of the S wave, when an RS complex is present is greater than 100 ms

3. Whether atrioventricular dissociation is present

4. Whether both leads V1 and V6 fulfilled classic criteria for ventricular tachycardia.

Four-step Brugada algorithm for the diagnosis of wide complex tachycardia.

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