By John R. Hampton DM MA DPhil FRCP FFPM FESC
This booklet deals a hundred and fifty 12-lead ECGs and rhythm strips, every one with a scientific case heritage and query. the total ECG is reproduced and a examine of it with the case heritage might be sufficient to offer a solution. at the again the case is tested, with an outline of the most good points of the ECG besides a scientific interpretation and a "what to do" part. The instances are graded in hassle.
"I could hugely suggest it, not just for my more youthful colleagues and scholars, but in addition to colleagues in several specialties." Reviewed by Perfusion, Apr 2015
For this Fourth version over 30 new ECGs were integrated, generally to supply clearer examples, even though the booklet intentionally keeps a few technically bad documents to keep up a ’real-world’ perspective.
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Additional info for 150 ECG problems
Although a Q wave is well developed in lead V3, the changes are entirely consistent with the story of pain for 1 h. What to do This patient needs pain relief with diamorphine. The ECG shows ST segments raised by more than 2 mm in several leads, so he needs immediate percutaneous coronary intervention (PCI) or thrombolysis once any risk of excessive bleeding has been excluded. This treatment should not be delayed by waiting for a chest X-ray or any other investigations. Ventricular extrasystoles do not need treating.
142, 8E 44 See p. 241, 6E I VR V1 V4 II VL V2 V5 III VF V3 V6 ECG 23 ECG 23 II This ECG and chest X-ray are from a 70-year-old man who had had angina for some time and was being treated with a beta-blocker. He came to the A & E department complaining of pain similar to his angina, but much more severe and persistent for 4 h. He had a heart murmur. What do the ECG and chest X-ray show and what treatment would be appropriate? 45 ANSWER 23 The ECG shows: • Atrial fibrillation; ventricular rate 62/min • Left axis deviation (left anterior hemiblock) • Broad QRS complexes (160 ms) • ‘M’ pattern of QRS complexes in leads V5–V6 • Inverted T waves in leads I, VL, V5–V6 The chest X-ray shows an enlarged left ventricle and a dilated ascending aorta.
Atrial extrasystoles are not a manifestation of cardiac disease, but the atrial tachycardia may be and will need treating on symptomatic grounds. What to do Ensure that there is no other evidence of heart disease. She should stop smoking and avoid alcohol, coffee and tea. A beta-blocker will probably prevent the tachycardia. Summary Sinus rhythm with atrial tachycardia and one atrial extrasystole. See p. 66, 8E 22 See p. 107, 6E I VR V1 V4 II VL V2 V5 III VF V3 V6 ECG 12 ECG 12 II A 70-year-old man had had high blood pressure for many years, but it was now well controlled at 140/85.
150 ECG problems by John R. Hampton DM MA DPhil FRCP FFPM FESC