Ebook Critical cases in electrocardiography: Part 2
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Ebook Critical cases in electrocardiography: Part 2
The Electrocardiography of Shortness of BreathChapterThere are at least three common "shortness of breathemergencies" - pulmonary thromboembolism, pen Ebook Critical cases in electrocardiography: Part 2ncardial effusion and myocarditis - where the ECG often provides the first diagnostic information While the ECG is not the definitive test for any of these conditions, the ECG is often the first test performed. In many cases, the ECG provides unmistakable clues that can guide initial treatment and f Ebook Critical cases in electrocardiography: Part 2urther diagnostic testing.. Pulmonary embolism (PE) is a common cause of dyspnea. The most common ECG abnormalities are sinus tachycardia: T-wave inveEbook Critical cases in electrocardiography: Part 2
rsions in leads VI. V2 and V3. a rightward QRS axis (or an axis that is more rightward than normal for the patient’s age): the S1-Q3-T3 pattern: and aThe Electrocardiography of Shortness of BreathChapterThere are at least three common "shortness of breathemergencies" - pulmonary thromboembolism, pen Ebook Critical cases in electrocardiography: Part 2develop a focal myocarditis: here, the ECG may show ST-segment elevations in a regional pattern (for example, suggesting inferior wall STEMI).Acute myocarditis is a “don’t-miss" diagnosis because patients may develop fulminant congestive heart failure or malignant ventricular arrhythmias.Shortness o Ebook Critical cases in electrocardiography: Part 2f breath is the most common symptom in patients with cardiac tamponade. The characteristic ECG findings include sinus tachycardia, low-voltage QRS comEbook Critical cases in electrocardiography: Part 2
plexes and. frequently, electrical alternans. Chronic emphysema also presents characteristic ECG changes. The most common are abnormal right axis deviThe Electrocardiography of Shortness of BreathChapterThere are at least three common "shortness of breathemergencies" - pulmonary thromboembolism, pen Ebook Critical cases in electrocardiography: Part 2he “Lead I sign.” and poor R-wave progression Tachycardias, including multifocal atrial tachycardia, also occur commonly in patients with severe emphysema, especially during hypoxic respiratory emergencies.inferior leads are a vital clue to the presence of acute PE. however, these T-wave inversions Ebook Critical cases in electrocardiography: Part 2are often misinterpreted by clinicians and computer algor ithms as "possible anterior ischemia, possible inferior ischemia.”. In patients with acute PEbook Critical cases in electrocardiography: Part 2
E. anterior T-wave inversions, an rSR’ complex in VI and acute right axis deviation are markers of acute pulmonary hypertension and right heart strainThe Electrocardiography of Shortness of BreathChapterThere are at least three common "shortness of breathemergencies" - pulmonary thromboembolism, pen Ebook Critical cases in electrocardiography: Part 2nd mortality.. Myocarditis often presents with dyspnea as well as chest pain, palpitations and. frequently, signs of congestive heart failure. Classically, a viral prodrome is present The combination of low voltage in the limb or precordial leads and sinus tachycardia should raise the suspicion of a Ebook Critical cases in electrocardiography: Part 2cute myocarditis The ECG may also demonstrate diffuse ST- and T-wave changes, including ST-segment elevations. ST-segment depressions. T-wave inversioEbook Critical cases in electrocardiography: Part 2
ns, premature atrial or ventricular beats and conduction abnormalities. Echocardiography is frequently the key test that defines the global wall motioThe Electrocardiography of Shortness of BreathChapterThere are at least three common "shortness of breathemergencies" - pulmonary thromboembolism, pen Ebook Critical cases in electrocardiography: Part 2 breath, in most cases, the diagnosis does not depend on the electrocardiogram. Pneumonia, asthma, emphysema, congestive heart failure, upper airway obstruction and other common conditions are usually evident after performing a careful history and physical examination.At the same time, there are at Ebook Critical cases in electrocardiography: Part 2least tluee common “shortness of breath emergencies” - pulmonary thromboembolism, pericar dial effusion and myocarditis - where the ECG often providesEbook Critical cases in electrocardiography: Part 2
the fust diagnostic information. Hie ECG is not the definitive test for any of these conditions, in terms of “diagnostic test characteristics" (sensiThe Electrocardiography of Shortness of BreathChapterThere are at least three common "shortness of breathemergencies" - pulmonary thromboembolism, pen Ebook Critical cases in electrocardiography: Part 2clues to these critical conditions.The ECG in Pulmonary EmbolismPulmonary embolism (PE) is a common cause of dyspnea. Even though the ECG is not a sensitive or specific test for acute pulmonary embolism and even though the exact160CbapTe. S: The aeet^oc https://khothuvien .comcontribution of the ECG Ebook Critical cases in electrocardiography: Part 2 to other clinical decision tools (for example. Wells. Geneva. PERC. the d-dimer or other cardiac biomarkers) is unknown, the ECG often presents earlyEbook Critical cases in electrocardiography: Part 2
clues to this diagnosis (Digby et al.. 2015). In addition. PE typically presents with chest pain, dyspnea, dizziness or syncope. Since virtually everThe Electrocardiography of Shortness of BreathChapterThere are at least three common "shortness of breathemergencies" - pulmonary thromboembolism, pen Ebook Critical cases in electrocardiography: Part 2 et al.. 2015).If sinus tachycardia and “nonspecific ST-T-wave changes” are included, the ECG is abnormal in most patients with an acute PE (Geibel et al.. 2005. Pollack 2006. Petrov. 2001: Ferrari et al.. 1997. Wagner and Strauss. 2014. Surawicz and Knilans. 2008. Chan et al.. 2005. Chan et al.. 20 Ebook Critical cases in electrocardiography: Part 201). The most common and helpful ECG findings are listed in the table and are described later.Increasingly, the ECG is recognized for providing valuabEbook Critical cases in electrocardiography: Part 2
le prognostic, as well as diagnostic, information in patients with suspected PE (Digby et al.. 2015). Many of the ECG abnormalities (for example, nghtThe Electrocardiography of Shortness of BreathChapterThere are at least three common "shortness of breathemergencies" - pulmonary thromboembolism, pen Ebook Critical cases in electrocardiography: Part 2ressures and right heart strain. They are associated with more severe pulmonary hypertension and right ventricular dysfunction: they are also associated with more extensive pulmonary' vascular obstruction (clot burden) and in-hospital complications, such as cardiogenic shock and mortality (Ferrari e Ebook Critical cases in electrocardiography: Part 2t al.. 1997; Geibel et al.. 2005: Petrov. 2001; Digby et al.. 2015). The ECG findings in patients with acute PE are often transient, and they may lessEbook Critical cases in electrocardiography: Part 2
en or disappear after successful lytic therapy (Surawicz and Knilans. 2008: Chan et al.. 2001).In 2015. Digby et al published a comprehensive review oThe Electrocardiography of Shortness of BreathChapterThere are at least three common "shortness of breathemergencies" - pulmonary thromboembolism, pen Ebook Critical cases in electrocardiography: Part 2cardia, right axis deviation. S1Q3T3. right bundle branch block and T-wave inversions in the right precordial and other leads. The review also highlighted several more recently recognized ECG manifestations of PE. including ST-segment elevations in VI. ST-segment elevations in aVR. QT prolongation a Ebook Critical cases in electrocardiography: Part 2nd low QRS voltage.Right Axis DeviationOne critical ECG clue to pulmonary embolism IS the finding of right axis deviation. The ỌRS axis must be interpEbook Critical cases in electrocardiography: Part 2
reted in light of the patient’s age. ECG textbooks and computer algorithms often assert that the QRS axis is abnormally rightward only if the measuredThe Electrocardiography of Shortness of BreathChapterThere are at least three common "shortness of breathemergencies" - pulmonary thromboembolism, pen Ebook Critical cases in electrocardiography: Part 2d children is rightward. reflecting the dominance of the right ventricle and right ventricular outflow tract. However, the axis shifts leftward as people age (Stephen. 1990. Wagner and Strauss. 2014. Surawicz and Knilans. 2008. Rijnbeek et al.. 2014). Therefore, any degree of rightward axis - that i Ebook Critical cases in electrocardiography: Part 2s. any visible S-wave in lead I - may be abnormal in patients older than age 45-50 years. In older patients with chest pain, dyspnea, syncope or otherEbook Critical cases in electrocardiography: Part 2
cardiovascular symptoms, the presence of an S-wave in lead I. signliying a QRS axis that IS abnormally rightward for the patient’s age.Box 5.1 ECG ClThe Electrocardiography of Shortness of BreathChapterThere are at least three common "shortness of breathemergencies" - pulmonary thromboembolism, pen Ebook Critical cases in electrocardiography: Part 2 both anterior precordial and inferior limb leads•Complete or incomplete right bundle branch block (rSR' in VI)•Atrial fibrillation or atrial flutter•Right atrial enlargement (P-pulmonale)may be the only clue to acute right heart strain and PE Examples are provided later in this chapter.S1-Q3-T3Whil Ebook Critical cases in electrocardiography: Part 2e sinus tachycardia is the most common ECG abnormality in patients with acute PE. the S1-Q3-T3 pattern is often considered a “classic” or even “pathogEbook Critical cases in electrocardiography: Part 2
nomonic" finding (Pollack 2006). However, the S1-Q3-T3 pattern is uncommon, and it is neither sensitive nor specific for acute PE.The most important cThe Electrocardiography of Shortness of BreathChapterThere are at least three common "shortness of breathemergencies" - pulmonary thromboembolism, pen Ebook Critical cases in electrocardiography: Part 2 It may reflect acute clockwise rotation of the heart due to right ventricular dilatation. This would result in an abnormal direction of septal and ventricular depolarization in a posterior and leftward direction (away from lead III) (Chan et al.. 2005).T-Wave Inversions Ebook Critical cases in electrocardiography: Part 2Gọi ngay
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