EKG QUIZ

1.Interpretation This EKG?
2.Differential Diagnosis of the cause in this EKG?

A 49-year-old woman,with a febrile sensation, fatigue, and weight loss (2 kg)

                  

A 49-year-old woman, with no history of heart disease, was admitted to the hospital with a febrile sensation, fatigue, and weight loss (2 kg). Three months ago, she was diagnosed as having a stricture of the pulmonary artery and suspicious pneumonia. So, the patient was treated empirically with antibiotics at another hospital. However the symptoms did not improve.

                 

On physical examination, the blood pressure was 130/80 mmHg, the heart rate was 68 beats/min and regular, and the
body temperature was 38C. On inspection, the conjunctivae were anemic.

                 Cardiac PE reveals :Clubbing and Cyanotic finger,JVP has giant a.Arterial pulse: Regular,Small volume pulse.No water hammer. Precordium: Apex is mild diffuse and lateral downward displace,No apical heave,Lt parasternal heave 3+,Palpable P2,No thrill

                Cardiac auscultation reveals: S1:Normal with S4 gallop, S2:Single and round, Murmur at ICS 2rd Lt parasternal as Systolic murmur grade3+ with roundP2 and then followed by soft high pitch short diastolic murmur

                Bedside Echocardiography Reveals as following picture

What is the Dx?(Cardiology QuiZ)

What is the cause of the Fever?(Infectious QuiZ)

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Thank you Professor Dr.Tada Yib in soi Who is my first and best Cardiology Teacher.He is the only one who inspire me to be the cardiologist.And he is the only one who make all of my knowledge in cardiology based on the simple basic science making very is Simply without rules.