1. Straight left heart border
2. Rounding of left heart border
3. Double cardiac shadow
4. Widening of the angle of carina
Select the correct answer using the code given below :
Chest X-ray Signs of Left Atrial Enlargement
The chest radiograph is a classic (if now largely superseded by echocardiography) tool for detecting left atrial (LA) enlargement. The correct answer is 1 and 3 only.
- 1. Straight left heart border — Normally the left heart border shows a gentle concavity below the pulmonary trunk (the "aortopulmonary window/left atrial appendage" segment). As the LA (and often its appendage) enlarges, it bulges outward and fills in this concavity, producing a straight or convex left heart border on the frontal film. Correct — this is a genuine, well-recognised sign of LA enlargement.
- 2. Rounding of the left heart border — A rounded, globular left heart border is the radiological signature of left ventricular dilatation, where the LV apex becomes more spherical and displaces laterally and downward. This is a distinct chamber from the left atrium and is not how LA enlargement presents. Incorrect.
- 3. Double cardiac shadow (double density/double contour sign) — When the LA enlarges, it expands posteriorly and to the right, projecting through the normal right heart border (formed by the right atrium). This creates a second, overlapping density visible within or just beyond the right heart border on the PA film. Correct — this is one of the most specific classic signs of LA enlargement.
- 4. Widening of the angle of carina — Splaying of the carinal angle occurs when the LA becomes markedly and chronically enlarged (as in long-standing mitral stenosis), elevating the left main bronchus and increasing the tracheobronchial angle beyond ~90°. However, this is a late and less specific sign, seen only with gross LA enlargement, and is not included among the core/classic signs expected in this answer code. Not included in the correct combination for this question.
Conclusion: The straight left heart border and the double cardiac shadow (statements 1 and 3) are the direct, specific radiographic hallmarks of left atrial dilatation, making option "1 and 3 only" the correct answer. Rounding of the left heart border reflects left ventricular, not atrial, enlargement, and carinal widening is an inconsistent, late finding rather than a core defining sign.
Important Questions from Heart Failure
High output cardiac failure is caused by which of the following diseases ?
1. Beri-beri
2. Severe anaemia
3. Thyrotoxicosis
Select the correct answer using the code given below:
- Kussmaul's sign is present in all of the following conditions, EXCEPT:
- Which of the following electro-cardio-graphic findings are manifestations of digitalis intoxication?
1. Ventricular bigeminy
2. Ventricular tachycardia
3. Atrial flutter
4. Atrial tachycardia with variable block
Select the correct answer using the code given below: - A 35-year-old labourer worker consulted a local medical practitioner for recurrent attack of chest pain. His elder brother had similar complaint and died at the age of 40 years. The labourer worker was advised to take sublingual nitroglycerin at the time of chest pain. But after taking nitroglycerin, the chest pain increased in intensity. Which one of the following is most likely ?
- The treatment of choice for a 32 year old male patient of severe mitral stenosis (Rheumatic) with thickened and calcified valves on echocardiography is:
