150 ECG Problems by David Adlam, John R. Hampton DM MA DPhil FRCP FFPM

By David Adlam, John R. Hampton DM MA DPhil FRCP FFPM FESC, Jo Hampton

Wow, do not cross go eyed but when it's a trend reputation ECG publication you wish, this is often it, you could have to learn the better half ECG made effortless first - or purchase them jointly.

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37 Jp~] See pp. 103 and 352 O This ECG was recorded from a 40-year-old man who complained of breathlessness on climbing stairs. He was not aware of a fast heart rate and had had no chest pain. Apart from a rapid rate there were no cardiovascular abnormalities, but he looked a little jaundiced and had an enlarged spleen. What would you do? ANSWER 27 The ECG shows: • • • • Atrial flutter Ventricular rate 140/min Left axis Normal QRS complexes, except that there is an S wave in lead V6 An echocardiogram is needed to assess left ventricular function, and digoxin could be given in an attempt to control the ventricular rate.

78 and 107 IP I See p. 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.

First degree block is not an indication for temporary pacing, but the patient must be monitored in case higher degrees of block develop. Summary ** First de ree block and 9 anterior non-Q-wave infarction. r^| See pp 3Q and 1Q3 I IP I See p.

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