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Điện tâm đồ

  1. Acute anterolateral stemi [150 ECG]

    Acute anterolateral STEMI



    ANSWER 101

    The ECG shows:
    • Sinus rhythm, rate 103/min
    • Normal axis
    • Normal QRS complexes
    • Raised ST segments in leads I, VL, V1–V6
    Clinical interpretation
    The ECG has the classic appearance of an acute anterolateral ST segment elevation myocardial infarction (STEMI).

    What to do
    Since this patient’s chest pain ...
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  2. Ventricular tachycardia [150 ECG]

    Ventricular tachycardia



    ANSWER 102

    The ECG shows:
    • Broad complex tachycardia at about 188/min
    • No P waves visible
    • Left axis deviation
    • QRS complex duration about 140 ms
    • Narrow fourth and fifth QRS complexes
    • QRS complexes that are probably concordant (in the chest leads all point upwards) though it is difficult to be certain
    Clinical interpretation ...
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  3. Sinoatrial disease with sinus rhythm and a junctional escape beat [150 ECG]

    Sinoatrial disease with sinus rhythm and a junctional escape beat



    ANSWER 103

    The ECG shows:
    • Variable QRS complex rate, average 31/min
    • Normal P waves in the first three beats; in the fourth beat the P wave immediately follows the QRS complex
    • Normal QRS complexes and T waves
    Clinical interpretation
    This is the ‘sick sinus syndrome’ or ‘sinoatrial disease’. ...
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  4. Atrial fibrillation; st segment elevation, partly ‘high take-off’ but mainly due to pericarditis [150 ECG]

    Atrial fibrillation; ST segment elevation, partly ‘high take-off’ but mainly due to pericarditis



    ANSWER 114

    The ECG shows:
    • Atrial fibrillation, average rate about 100/min
    • Normal axis
    • Normal QRS complexes
    • Raised ST segments in leads I, II, III, VF, V2–V6
    • In leads V3 and V4 the raised ST segments seem to be due to ‘high take-off’
    Clinical interpretation ...
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  5. The lgl syndrome [150 ECG]

    The LGL syndrome



    ANSWER 115

    The ECG shows:
    • Sinus rhythm, rate 64/min, with ventricular extrasystoles
    • Very short PR interval
    • Normal axis
    • Normal QRS complexes and T waves, apart from a small Q wave and an inverted T wave in lead III
    Clinical interpretation
    This is the Lown–Ganong–Levine (LGL) syndrome. Unlike the Wolff–Parkinson– White (WPW) syndrome, ...
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  6. Acute inferior myocardial infarction [150 ECG]

    Acute inferior myocardial infarction



    ANSWER 127

    The ECG shows:
    • Sinus rhythm
    • Normal axis
    • Q waves in leads II, III, VF
    • Elevated ST segments in leads II, III, VF, with biphasic T waves
    • Downward-sloping ST segments in lead VL
    • Normal QRS complexes, ST segments and T waves in the chest leads
    Clinical interpretation
    This is an acute ST segment ...
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  7. Left atrial and left ventricular hypertrophy [150 ECG]

    Left atrial and left ventricular hypertrophy



    ANSWER 128

    The ECG shows:
    • Sinus rhythm, rate 60/min
    • Bifid P wave (best seen in lead V3) suggesting left atrial hypertrophy
    • Left ventricular hypertrophy by ‘voltage criteria’ (height of R wave in lead V6 plus depth of S wave in lead V2 = 50 mm)
    • Lateral T wave inversion
    Clinical interpretation
    These are the ...
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  8. Widespread st segment elevation, suggesting pericarditis [150 ECG]

    Widespread ST segment elevation, suggesting pericarditis



    ANSWER 139

    The ECG shows:
    • Sinus rhythm, rate 105/min
    • Normal axis
    • Normal QRS complexes
    • Raised ST segments in leads I–III, VF, V4–V6
    Clinical interpretation
    The raised ST segments in leads I and V4 follow S waves, and are therefore ‘high take-off’ and of no significance. The ST segment elevation ...
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  9. Right atrial hypertrophy and chronic obstructive pulmonary disease [150 ECG]

    Right atrial hypertrophy and chronic obstructive pulmonary disease





    ANSWER 140

    The ECG shows:
    • Sinus rhythm, rate 102/min
    • Peaked P waves, best seen in leads V1–V2
    • Right axis deviation (deep S waves in lead I)
    • RSR1 pattern with normal QRS complex duration in lead V1 (partial right bundle ...
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  10. Marked prolongation of the qt interval – long qt syndrome [150 ECG]

    Marked prolongation of the QT interval – long QT syndrome



    ANSWER 141

    The ECG shows:
    • Sinus rhythm, rate 91/min
    • Normal PR interval
    • Normal axis
    • Normal QRS complexes
    • Prolonged QT interval (QT = 492 ms; QTc = 598 ms)
    • Inverted T waves in leads V2–V5
    Clinical interpretation
    This is clearly a very abnormal ECG, with a markedly prolonged QT interval ...
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