By David Adlam, John R. Hampton DM MA DPhil FRCP FFPM FESC, Jo Hampton
Wow, do not move go eyed but when it's a trend acceptance ECG publication you wish, this can be it, you could have to learn the spouse ECG made effortless first - or purchase them jointly.
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Extra resources for 150 ECG Problems
Example text
ANSWER 25 3z ] The ECG shows: • • • • • m TO I M Sinus rhythm Normal axis Q waves in leads II, III, VF Normal QRS complexes in the anterior leads Marked ST segment elevation in leads V1-V6 Clinical interpretation The Q waves in leads III and VF suggest an old inferior infarction, while the elevated ST segments in leads V1-V6 indicate an acute anterior infarction. What to do The patient should be given pain relief, and in the absence of the usual contraindications should immediately be treated with aspirin and a thrombolytic agent.
You find that he has a systolic heart murmur, and this is his ECG. What is the diagnosis and what do you do next? t O ANSWER 18 The ECG shows: I m 73 • Sinus rhythm, rate 48/min • Normal axis • QRS duration normal, but the R wave height in lead V5 is 30 mm, and the S wave depth in lead V2 is 25 mm • Inverted T waves in leads I, VL, V5-V6 oo Clinical interpretation This is the classical ECG appearance of left ventricular hypertrophy. What to do The combination of dizziness on exercise, a systolic murmur, and evidence of left ventricular hypertrophy suggests significant aortic stenosis.
What to do Right bundle branch block is seen in a small proportion of people with perfectly normal hearts. In the presence of a heart murmur, however, the possibility of an atrial septal defect should be considered. This is what this patient had. The physical signs were a widely-split pulmonary second sound which did not vary with inspiration (this is typical of right bundle branch block) and an ejection systolic murmur best heard at the left sternal edge. On deep inspiration a soft diastolic Summary Sinus rhythm with right bundle branch block.