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ID:33378138
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页数:65页
时间:2018-05-24
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1、ischaemicheartdiseaseCurtisLiPolymorphousventriculartachycardia(Torsadedepointes).A60yearoldmanwithIschaemicHeartDiseasePolymorphousventriculartachycardia(Torsadedepointes).ThisisaformofVTwherethereisusuallynodifficultyinrecognisingitsventricularorigin.wideQRScomplexesw
2、ithmultiplemorphologieschangingR-Rintervalstheaxisseemstotwistabouttheisoelectriclineitisimportanttorecognisethispatternasthereareanumberofreversiblecausesheartblockhypokalaemiaorhypomagnesaemiadrugs(e.g.tricyclicantidepressantoverdose)congenitallongQTsyndromesothercaus
3、esoflongQT(e.g.IHD)ThisrecordinghasbeenkindlydonatedbyDrG.ButrousofStGeorge'sMedicalSchoolLondonwhoisacardiologistinvolvedinEUROTOP.A55yearoldmanwith4hoursof"crushing"chestpain.AcuteinferiormyocardialinfarctionSTelevationintheinferiorleadsII,IIIandaVFreciprocalSTdepress
4、ionintheanteriorleadsA63yearoldwomanwith10hoursofchestpainandsweating.AcuteanteriormyocardialinfarctionSTelevationintheanteriorleadsV1-6,IandaVLreciprocalSTdepressionintheinferiorleadsA60yearoldwomanwith3hoursofchestpain.Acuteposteriormyocardialinfarction(hyperacute)the
5、mirrorimageofacuteinjuryinleadsV1-3(fullyevolved)tallRwave,talluprightTwaveinleadsV1-3usuallyassociatedwithinferiorand/orlateralwallMIA53yearoldmanwithIschaemicHeartDisease.OldinferiormyocardialinfarctionaQwaveinleadIIIwiderthan1mm(1smallsquare)andaQwaveinleadaVFwide
6、rthan0.5mmandaQwaveofanysizeinleadIIA79yearoldmanwith5hoursofchestpain.AcutemyocardialinfarctioninthepresenceofleftbundlebranchblockFeaturessuggestingacuteMISTchangesinthesamedirectionastheQRS(asshownhere)STelevationmorethanyou'dexpectfromLBBBalone(e.g.>5mminleadsV1-
7、3)Qwavesintwoconsecutivelateralleads(indicatinganteroseptalMI)ventricularrhythmsAladywithRomano-WardsyndromeLongQTintervalLongQTintervalTheQTintervalnormallyvarieswithheartrate-becomingshorteratfasterrates.Itisusuallycorrectedusingthecyclelength(R-Rinterval)asshownoppo
8、site.normalQTc=0.42secondsRomano-WardsyndromeisanautosomaldominantlyinheritedformoflongQTintervalandthereisar
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