By John R. Hampton DM MA DPhil FRCP FFPM FESC
This booklet deals a hundred and fifty 12-lead ECGs and rhythm strips, each one with a medical case historical past and query. the whole ECG is reproduced and a examine of it with the case background may be sufficient to offer a solution. at the again the case is tested, with an outline of the most positive factors of the ECG besides a medical interpretation and a "what to do" part. The circumstances are graded in hassle.
"I may hugely suggest it, not just for my more youthful colleagues and scholars, but additionally to colleagues in several specialties." Reviewed by Perfusion, Apr 2015
For this Fourth version over 30 new ECGs were incorporated, mostly to supply clearer examples, although the e-book intentionally keeps a few technically terrible documents to keep up a ’real-world’ perspective.
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Additional info for 150 ECG problems
What to do When an arrhythmia causes severe heart failure, immediate treatment is more important than establishing the underlying diagnosis. Carotid sinus pressure and adenosine may increase the degree of block, but are unlikely to convert the heart to sinus rhythm. It is worth trying intravenous flecainide, but a patient with severely compromised circulation is best promptly treated with DC cardioversion. In the long term, ablation therapy to prevent further episodes of atrial flutter may be needed.
The attacks stop suddenly after a few minutes. There are no abnormalities on examination, and this is his ECG. What would you do? 29 ANSWER 15 The ECG shows: • Sinus rhythm, rate 56/min • Short PR interval, most obvious in the chest leads • Normal axis • Wide QRS complexes (136 ms) • Slurred upstroke of the QRS complex (delta wave) • Dominant R wave in lead V1 Clinical interpretation This ECG is classic of Wolff–Parkinson–White (WPW) syndrome. The resemblance to the ECG of right ventricular hypertrophy is because this is WPW type A, with a left-sided accessory pathway.
What to do This patient has angina, and the chest X-ray suggests aortic stenosis. LBBB is characteristic of severe aortic stenosis. The problem is deciding whether his episode of severe pain is due to a bad attack of angina or to a myocardial infarction. An aortic dissection is also a possibility. Percutaneous coronary intervention (PCI) or thrombolytic agents should not be given unless there is evidence from previous records that the LBBB is new, and treatment will depend on whether the plasma troponin level is elevated.
150 ECG problems by John R. Hampton DM MA DPhil FRCP FFPM FESC