A concertina is a free-reed musical instrument, It consists of expanding and contracting bellows, with buttons (or keys) usually on both ends, unlike accordion buttons, which are on the front.
Concertina effect is seen in medicine in which of following conditions? Choose the correct responses?
- Coronary angioplasty due to guidewire
- WPW syndrome
- Intestinal obstruction
- coronary angioplasty due to stent strut compression
- Right atrial pectinate muscle

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Answer is all of the above.
In coronary angioplasty stiff guidewire in tortous lesions can cause this appearance of pseudolesions .These are not entirely benign and can cause ischemia at times.
In WPW syndrome there is progressive shortening of PR interval with widening of QRS denoting longer RP of accessory pathway and is a favorable feature.
Concertina in abdominal radiograph may be showing jejunal loops.
Longitudinal deformation of stent can cause a concertina effect and need post dilation.
Right atrial pectinate muscles are thought to have a concertina like response to volume loading for accomodating hemodynamic changes
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