salmonella
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45)A 62 year old man on the cardiology ward presents with the history of myocardial infarction .ECGshows a broadened QRS complex NO R waves in v1 and a tall wide R wave in v6 .SPLITTING of s2 heart sound increases upon exp and decreases upon inspiration what underlying pathology explain thia
a...AV nodal reentry
b....damage to left bndle bracnh
c.....damage to right bundle branch
d first degree av block
e .....pre excitation syndrome
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| new_n_lost
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b....damage to left bndle bracnh
Is this an NBME Q plz Respond
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| salmonella
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well done
no this is physio q bank
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| salmonella
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ischemic damage to left bundle branch means that septal and left ventricular depolarization must now originate from right ventricle .
the prolonged late conduction thru left vent myocardium broadens the QRS complex in v6 and diminished R wave in v1. Normal S2 splitting increases during inspiration as the increased venous return to the thoracic cavity increases right ventricular volume, prolonged ejection time and consequently delayed pulmonic valve closure, P2 which normally folows A2 moves further from A2
S2 splitting that decreases upon inspiration is most commonly caused by left bundle branch block.The closing of aortic valve is abnormally delayed so that A2 is actually following P2 and the delay pulmonic valve closure during inspiration brings P2 closure to A2.
Edited by new_n_lost on 04/08/07 - 09:55 PM
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| salmonella
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are phir kuch na khuch spelling mistake ho gai
chalo next time i will be careful
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