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(BMJ Books) Quick-reference textual content permits readers to familiarize yourself with the wide variety of electrocardiogram styles noticeable in scientific perform. For these ordinarily perform or in hospitals coping with sufferers with middle problems. Softcover.
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Additional resources for ABC of Clinical Electrocardiography
In patients with previous Q wave myocardial infarction the hallmark of new ischaemia is often ST segment elevation. This is thought to be associated with a wall motion abnormality, or bulging of the infarcted segment. It rarely indicates reinfarction in the same territory. When an electrocardiogram shows persistent T wave inversion accompanying the changes of a previous acute myocardial infarction, ischaemia in the same territory may cause “normalisation” of the T waves (return to an upright position).
It is much less common than torsades de pointes. If sustained, polymorphic ventricular tachycardia often leads to haemodynamic collapse. It can occur in acute myocardial infarction and may deteriorate into ventricular fibrillation. Polymorphic ventricular tachycardia must be differentiated from atrial fibrillation with pre-excitation, as both have the appearance of an irregular broad complex tachycardia with variable QRS morphology (see last week’s article). Causes of torsades de pointes Drugs x Antiarrhythmic drugs: class Ia (disopyramide, procainamide, quinidine); class III (amiodarone, bretylium, sotalol) x Antibacterials: erythromycin, fluoquinolones, trimethoprim x Other drugs: terfenadine, cisapride, tricyclic antidepressants, haloperidol, lithium, phenothiazines, chloroquine, thioridazine Electrolyte disturbances x Hypokalaemia x Hypomagnesaemia Congenital syndromes x Jervell and Lange-Nielsen syndrome x Romano-Ward syndrome Other causes x Ischaemic heart disease x Myxoedema x Bradycardia due to sick sinus syndrome or complete heart block x Subarachnoid haemorrhage Polymorphic ventricular tachycardia deteriorating into ventricular fibrillation Broad complex tachycardias of supraventricular origin In the presence of aberrant conduction or ventricular pre-excitation, any supraventricular tachycardia may present as a broad complex tachycardia and mimic ventricular tachycardia.
Torsades de pointes is not usually sustained, but it will recur unless the underlying cause is corrected. Occasionally it may be prolonged or degenerate into ventricular fibrillation. It is associated with conditions that prolong the QT interval. Transient prolongation of the QT interval is often seen in the acute phase of myocardial infarction, and this may lead to Fascicular ventricular tachycardia (note the right bundle branch block pattern and left axis deviation) I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 Right ventricular outflow track tachycardia Torsades de pointes may be drug induced or secondary to electrolyte disturbances Torsades de pointes 25 ABC of Clinical Electrocardiography torsades de pointes.