教学讲稿心电图图例

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1、ischaemicheartdiseaseCurtisLiPolymorphousventriculartachycardia(Torsadedepointes).A60yearoldmanwithIschaemicHeartDiseasePolymorphousventriculartachycardia(Torsadedepointes).ThisisaformofVTwherethereisusuallynodifficultyinrecognisingitsventricularorigin.wideQRScomplexeswithmultiplemor

2、phologieschangingR-Rintervalstheaxisseemstotwistabouttheisoelectriclineitisimportanttorecognisethispatternasthereareanumberofreversiblecausesheartblockhypokalaemiaorhypomagnesaemiadrugs(e.g.tricyclicantidepressantoverdose)congenitallongQTsyndromesothercausesoflongQT(e.g.IHD)Thisrecor

3、dinghasbeenkindlydonatedbyDrG.ButrousofStGeorge'sMedicalSchoolLondonwhoisacardiologistinvolvedinEUROTOP.A55yearoldmanwith4hoursof"crushing"chestpain.AcuteinferiormyocardialinfarctionSTelevationintheinferiorleadsII,IIIandaVFreciprocalSTdepressionintheanteriorleadsA63yearoldwomanwith10

4、hoursofchestpainandsweating.AcuteanteriormyocardialinfarctionSTelevationintheanteriorleadsV1-6,IandaVLreciprocalSTdepressionintheinferiorleadsA60yearoldwomanwith3hoursofchestpain.Acuteposteriormyocardialinfarction(hyperacute)themirrorimageofacuteinjuryinleadsV1-3(fullyevolved)tallRw

5、ave,talluprightTwaveinleadsV1-3usuallyassociatedwithinferiorand/orlateralwallMIA53yearoldmanwithIschaemicHeartDisease.OldinferiormyocardialinfarctionaQwaveinleadIIIwiderthan1mm(1smallsquare)andaQwaveinleadaVFwiderthan0.5mmandaQwaveofanysizeinleadIIA79yearoldmanwith5hoursofchestpai

6、n.AcutemyocardialinfarctioninthepresenceofleftbundlebranchblockFeaturessuggestingacuteMISTchangesinthesamedirectionastheQRS(asshownhere)STelevationmorethanyou'dexpectfromLBBBalone(e.g.>5mminleadsV1-3)Qwavesintwoconsecutivelateralleads(indicatinganteroseptalMI)ventricularrhythmsAla

7、dywithRomano-WardsyndromeLongQTintervalLongQTintervalTheQTintervalnormallyvarieswithheartrate-becomingshorteratfasterrates.Itisusuallycorrectedusingthecyclelength(R-Rinterval)asshownopposite.normalQTc=0.42secondsRomano-WardsyndromeisanautosomaldominantlyinheritedformoflongQTinterval

8、andthereisar