By Francis Morris; William Brady; A John Camm
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Extra resources for ABC of clinical electrocardiography
6 ST changes with ischaemia showing normal wave form (a); ﬂattening of ST segment (b), making T wave more obvious; horizontal (planar) ST segment depression (c); and downsloping ST segment depression (d). 7 Subtle ST segment change in patient with ischaemic chest pain: when no pain is present (a) and when in pain (b). 9 Widespread ST segment depression in patient with unstable angina (diagram is scaled up). 2/7/2008 12:04:07 PM 44 ABC of Clinical Electrocardiography (a) “normalisation” of the T waves (return to an upright position).
Inappropriate concordance strongly indicates acute ischaemia. Extreme ST segment elevation (≥ 5 mm) in leads V1 and V2 also suggests acute ischaemia. If doubt persists, serial electrocardiograms may show evolving changes. 3 ST segment depression in precordial leads in 68 year old man with chest pain. 2 Acute myocardial infarction and left bundle branch block. Note that the ST segments are elevated in leads V5 and V6 (inappropriate concordance) and grossly elevated (> 5 mm) in leads V2, V3, and V4; note also the ST segment depression in leads III and aVF.
Indd 26 2/7/2008 12:00:54 PM CHAPTER 7 Broad Complex Tachycardia—Part II June Edhouse, Francis Morris This chapter continues the discussion on ventricular tachycardias and also examines how to determine whether a broad complex tachycardia is ventricular or supraventricular in origin. I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 Ventricular tachycardias Fascicular tachycardia Fascicular tachycardia is uncommon and not usually associated with underlying structural heart disease. It originates from the region of the posterior fascicle (or occasionally the anterior fascicle) of the left bundle branch and is partly propagated by the His-Purkinje network.
ABC of clinical electrocardiography by Francis Morris; William Brady; A John Camm