By David Adlam, John R. Hampton DM MA DPhil FRCP FFPM FESC, Jo Hampton
Wow, do not move pass eyed but when it's a development reputation ECG booklet you wish, this is often it, you could have to learn the significant other ECG made effortless first - or purchase them jointly.
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Additional info for 150 ECG Problems
315 1 rn 73 ro ^ A 60-year-old man, who 3 years earlier had had a myocardial infarction followed by mild angina, was admitted to hospital with central chest pain that had been present for 1 h and had not responded to sublingual nitrates. What does his ECG show, and what would you do? 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.
Clinical interpretation Right bundle branch block. 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.
What to do This patient needs pain relief with diamorphine. The ECG shows raised ST segments of more than 2 mm in several leads, so he needs immediate thrombolysis once any excess risk of bleeding has been excluded. This treatment should not be delayed by waiting for a chest X-ray or any other investigations, and should be commenced in the > Summary Acute anterolateral myocardial infarction. See p. 96 See p. 242 ECG 18 A 70-year-old retired orthopaedic surgeon telephones to say that he always gets dizzy playing golf.