By David Kerr, Annie Young, Richard Hobbs
(BMJ Books) Univ. of Birmingham, united kingdom. Covers key parts of sufferer care and gives debate round the a number of uncertanties in regards to the disorder. colour illustrations. Softcover.
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Additional resources for ABC of Clinical Electrocardiography
Isolated tall T waves in leads V1 to V3 may also be due to ischaemia of the posterior wall of the left ventricle (the mirror image of T wave inversion). Tall T waves in leads V2 and V3 in patient with recent inferoposterior myocardial infarction, indicating posterior ischaemia V1 V4 V2 V5 V3 V6 Tall T waves in myocardial ischaemia 37 ABC of Clinical Electrocardiography As there are other causes of abnormally tall T waves and no commonly used criteria for the size of T waves, these changes are not always readily appreciated without comparison with a previous electrocardiogram.
Appropriate discordance in uncomplicated left bundle branch block (note ST elevation in leads V1 to V3) I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 Acute myocardial infarction and left bundle branch block. Note that the ST segments are elevated in leads V5 and V6 (inappropriate concordance) and grossly elevated (> 5 mm) in leads V2, V3, and V4; note also the ST segment depression in leads III and aVF 33 ABC of Clinical Electrocardiography I aVR V1 V4 II aVL V2 V5 A B III aVF V3 Inappropriate concordance in lead V1 in patient with left bundle branch block (A); inappropriate concordance in lead V6 in patient with left bundle branch block (B); and exaggeration of appropriate discordance in lead V1 in patient with left bundle branch block (C) C V6 ST segment depression in precordial leads in 68 year old man with chest pain I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 Development of left bundle branch block in same man shortly after admission (note ST segment depression in lead V3; this is an example of inappropriate concordance) Right bundle branch block Right bundle branch block is most commonly seen in association with coronary artery disease, but in many cases no organic heart disease is present.
Alternatively, further ischaemia may make the T wave inversion more pronounced. Non-ischaemic ST segment changes: in patient taking digoxin (top) and in patient with left ventricular hypertrophy (bottom) Normalisation of longstanding inverted T waves in patient with chest pain Arrhythmias associated with acute myocardial ischaemia or infarction Ventricular myocardial ischaemia may be arrhythmogenic, and extrasystoles are common. It used to be thought that frequent extrasystoles of multifocal origin, bigeminy, couplets, or extrasystoles that fell on the T wave (R on T) conferred a bad prognosis in the early hours of myocardial infarction and Reversible ST segment changes in patient with chest pain; the ST segment elevation returns to normal as the chest pain settles 39 ABC of Clinical Electrocardiography predicted the onset of ventricular fibrillation.
ABC of Clinical Electrocardiography by David Kerr, Annie Young, Richard Hobbs