By David Kerr, Annie Young, Richard Hobbs
(BMJ Books) Univ. of Birmingham, united kingdom. Covers key components of sufferer care and gives debate round the various uncertanties concerning the ailment. colour illustrations. Softcover.
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Extra info for ABC of Clinical Electrocardiography
Atrial fibrillation In patients without an accessory pathway the atrioventricular node protects the ventricles from the rapid atrial activity that occurs during atrial fibrillation. In the Wolff-Parkinson-White syndrome the atrial impulses are conducted down the accessory pathway, which may allow rapid conduction and consequently very fast ventricular rates. The impulses conducted via the accessory pathway produce broad QRS complexes. Occasionally an impulse will be conducted via the atrioventricular node and produce a normal QRS complex or a fusion beat.
A Maximum predicted heart rate Acute myocardial infarction (within 4-6 days) Unstable angina (rest pain in previous 48 hours) Uncontrolled heart failure Acute myocarditis or pericarditis Acute systemic infection Deep vein thrombosis Uncontrolled hypertension (systolic blood pressure > 220 mm Hg, diastolic > 120 mm Hg) Severe aortic stenosis Severe hypertrophic obstructive cardiomyopathy Untreated life threatening arrhythmia Dissecting aneurysm Recent aortic surgery J point Top: At rest. Bottom: Pathological ST segment depression as measured 80 ms from J point B C Normal changes from rest (A), after three minutes’ exercise (B), and after six minutes’ exercise (C).
Occasionally the arrhythmia stops with adenosine treatment and so may be misdiagnosed as a supraventricular tachycardia. Torsades de pointes tachycardia Torsades de pointes (“twisting of points”) is a type of polymorphic ventricular tachycardia in which the cardiac axis rotates over a sequence of 5-20 beats, changing from one direction to another and back again. The QRS amplitude varies similarly, such that the complexes appear to twist around the baseline. In sinus rhythm the QT interval is prolonged and prominent U waves may be seen.
ABC of Clinical Electrocardiography by David Kerr, Annie Young, Richard Hobbs