By Richard A. Harrigan MD, William J. Brady MD, Theodore C. Chan MD
ECG in Emergency drugs: a subject of Emergency medication Clinics ЧЕЛОВЕК,ЗДОРОВЬЕ Название: ECG in Emergency medication: a subject of Emergency drugs Clinics Автор:Richard A. Harrigan, William J. Brady, Theodore C. Chan Год: 2007 г. Страниц: 240 стр. Формат: PDF Язык: Английский Издание:ELSEVIER Размер: 13.6 Mb ISВN 9781416033776 Description: For the fist time in 25 years, the Emergency drugs Clinics of North the USA good points a topic dedicated completely to the electrocardiogram (ECG) and its priceless position to physicians at the entrance line. This low-cost, effortless to exploit software yields a wealth of knowledge to emergency medication physicians. conventional makes use of corresponding to the prognosis of dysrhythmia and acute coronary syndromes are expertly distinctive, and nontraditional themes of ECG interpretation also are incorporated reminiscent of detection of electrode misconnection and artifact. do not pass over this one!"Мир книг"-является крупнейшим книжным сайтом. Тут представлено более a hundred and twenty 000книг и журналов. Ежедневно сайт пополняется на300 новых публикаций.Мы рекомендуем Вам зарегистрироваться либо зайти на сайт под своим именем. Зарегистрироваться? eighty five
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Hence, AMI is now classiﬁed as STEMI or NSTEMI. A normal Q wave representing the rapid depolarization of the thin septal wall between the two ventricles may be found in most leads (Box 1). This initial negative deﬂection of the QRS complex is of short duration and of low amplitude. Pathologic Q waves, often a consequence of MI, are generally wider and deeper than normal Q waves. Following MI with signiﬁcant Box 1. 04 sec. A Q wave of depth >25% of R wave height is often quoted as diagnostic, but width is more important than depth Leads III, aVR, V1: normal subjects may have nonpathologic wide and deep Q waves Adapted with permission from Smith SW, Zvosec DL, Sharkey SW, Henry TD.
Such extensive and profound STE is especially true in the presence of RV hypertrophy [34,159]. When RCA occlusion is suspected, record a right-sided ECG in which lead V1 becomes lead V2R, lead V2 becomes lead V1R, and leads V3R– Fig. 26. STEMI in the presence of LBBB. The previous ECG (not shown) had LBBB with typical discordant ST segments and T waves. There is now concordant STE and upright T waves in leads I, aVL, V5, and V6. There is concordant reciprocal STD in the inferior leads II, III, and aVF.
RBBB with AMI from proximal LAD occlusion. In the presence of RBBB, STE (leads V2–V6, I, and aVL) and reciprocal STD (leads II, III, and aVF) are seen clearly as long as the end of the QRS complex is properly located. Note that in lead V1, although the T wave is appropriately discordant for RBBB, the ST segment is inappropriately normal; it would be expected to be depressed in nonischemic RBBB. 78 SMITH & WHITWAM Box 2. Sgarbossa criteria for diagnosis of STEMI in the presence of LBBB Concordant ST segment elevation ‚1 mm in one or more leads, which means ST segment elevation in leads in which the QRS complex is predominantly positive (V5, V6, I, aVL, or II) Concordant ST segment depression ‚1 mm in one or more leads (ie, ST segment depression in leads in which QRS complex is predominantly negative [V1, V2, V3]); this is 90% specific for AMI caused by posterior injury Discordant ST segment elevation ‚5 mm that is excessive (out of proportion) to the depth of the preceding S wave seems to be approximately 90% specific for AMI is often associated with conduction defects at the AV node, including complete heart block.
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