Echo: Vein of Galen Malformation

Dabigatran - Alternative for Warfarin

RE-LY trial in patients with Atrial fibrillation.
Dabigatran was approved by FDA on 10/20/10.
See the posting on Journal Club.

Anti-platelet agents...to be expanded further.

Antiplatelet drugs alter the platelet activation at the site of vascular damage crucial to the development of arterial thrombosis.

irreversibly inhibits the enzyme COX, resulting in reduced platelet production of TXA2 (thromboxane - powerful vasoconstrictor which lowers cyclic AMP and initiates the platelet release reaction).

inhibits platelet phosphodiesterase, causing an increase in cyclic AMP with potentiation of the action of PGI2 – opposes actions of TXA2

affects the ADP-dependent activation of IIb/IIIa complex

Glycoprotein IIb/IIIa receptor antagonists block a receptor on the platelet for fibrinogen and von Willebrand factor. 3 classes:
Murine-human chimeric antibodies (e.g. abciximab)
Synthetic peptides (e.g. eptifibatide)
Synthetic non-peptides (e.g. tirofiban)


EKG: Interpret this...

2 yr old, postop. VSD. Returned from operating room 2 hrs ago.
What is the rhythm?
Where are the P waves?
Just a little help to identify P waves: Atrial lead is connected in V1.

Atrial Lead is connected in V1, now recorded at 50 mm/sec paper speed - to help with identifying P waves:


EKG: Interpret this, Learn Ladder Diagram

What is happening after the PVC?
Originally posted by
Dr Kyuhyun Wang, Clinical Professor of Medicine, University of Minnesota, Minneapolis, MN.
Link to the original article in HeartWire: http://www.theheart.org/article/1130549.do


EKG: Low Voltage Complexes & Lead Misplacement

Low voltage complexes. Cause of this is evident in the CXR below.

What is the P wave axis? What will be the diagnosis for the unusual P wave axis?

If unusual P wave axis were to be due to misplacement of leads, which leads were misplaced?

If certain leads were misplaced...what would be the QRS axis, if the misplaced leads were


What is the mistake?

Infant, s/p Repair of AVSD (Postop. day 8)
Postoperative Heart Block
Temporary pacemaker setting: DDD @ 90 bpm.
What is the mistake made by the nurse? (or the resident, or the fellow...attending would not have done it!!)