Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2
Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2
Wide QRS Complex Tachycardia in the Emergency Setting6Giuseppe Oreto, Francesco Luzza, Gaetano Satullo, Antonino Donato, Vincenzo Carbone, and Maria P Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2Pia Calabro6.1Wide QRS Complex TachycardiaA wide QRS complex tachycardia can be (1) ventricular tachycardia (VT); (2) supraventricular tachycardia (SVT) with bundle branch block that may be either preexisting or due to aberrant conduction, namely, tachycardia-dependent abnormal intraventricular cond Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2uction; a further possibility is the effect of some anliarrhythmic drugs that slow down intraventricular conduction, resulting in marked QRS complex wEbook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2
idening: and (3) supraventricular tachycardia with conduction of impulses to the ventricles over an accessory pathway (preexcited tachycardia).In the Wide QRS Complex Tachycardia in the Emergency Setting6Giuseppe Oreto, Francesco Luzza, Gaetano Satullo, Antonino Donato, Vincenzo Carbone, and Maria P Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2f VT. and some drugs useful in the former (e.g., verapamil) are harmful in the latter [1-3].The origin of a wide QRS complex tachycardia can be reliably identified using a “holistic” approach, namely, taking into account all of the available items: no single criterion is able to provide a simple and Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2 quick solution of the problem in all cases. The available ECG signs are. without any exception, suggestive of ectopy. namely, ventricular origin of tEbook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2
he impulses: SVT with aberrant conduction may only be diagnosed by excluding all of the items favoring VT. The recognition of ventricular or supraventWide QRS Complex Tachycardia in the Emergency Setting6Giuseppe Oreto, Francesco Luzza, Gaetano Satullo, Antonino Donato, Vincenzo Carbone, and Maria P Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2ine, University of Messina.Messina. Italye-mail: goreto@unime.itG. Satullo • A. DonatoDepartment of Cardiology. “Papardo” Hospital. Messina. ItalyM.p. CalabroDepartment of Pediatrics. University of Messina. Messina. Italy© Springer International Publishing Switzerland 201689M. Zecchin. G. Sinagra (e Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2ds.). The Arrhythmic Patient in the Emergency Department: A Practical Guide for Cardiologists and Emergency Physicians. nnt in innt/me 1 Ì1O 1 A90G.OrEbook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2
eto etal.detailed analysis is used, taking into account several diagnostic signs: [4-12] the idea that a single quick item can offer an immediate and Wide QRS Complex Tachycardia in the Emergency Setting6Giuseppe Oreto, Francesco Luzza, Gaetano Satullo, Antonino Donato, Vincenzo Carbone, and Maria P Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2ventricular origin of the arrhythmia since (1) a wide QRS tachycardia is more likely VT than SVT and (2) it is less dangerous to treat an SVT like it were ventricular in origin than applying to a patient with VT the treatment commonly used for SVTs. Ill particular, intravenous verapamil should be av Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2oided whenever SVT diagnosis is not certain, since this drug is harmful in some VT patients [1-3].6.2General Criteria6.2.1 Atrioventricular DissociatiEbook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2
onWhenever the electrical activity of the atria is recognizable, two different situations may occur:1Atrioventricular (A-V) dissociation2Relationship Wide QRS Complex Tachycardia in the Emergency Setting6Giuseppe Oreto, Francesco Luzza, Gaetano Satullo, Antonino Donato, Vincenzo Carbone, and Maria P Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2rom 19 to 70 % of VT cases [5. 6. IO, II]. Dissociation, however, is often difficult to be diagnosed since in several cases, sinus p waves are not easily recognizable, being simultaneous to ỌRS complexes or T waves. Moreover, in the presence of atrial fibrillation. A-V dissociation cannot be appreci Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2ated. Before excluding, in a wide ỌRS complexes tachycardia, the presence of p waves independent of QRS complexes, however, one should observe with grEbook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2
eat attention the configuration of several consecutive complexes in all 12 leads, paying the greatest attention to leads II and VI (the ones where sinWide QRS Complex Tachycardia in the Emergency Setting6Giuseppe Oreto, Francesco Luzza, Gaetano Satullo, Antonino Donato, Vincenzo Carbone, and Maria P Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2 this approach it is not rare to discover. in the presence of VT. that in some leads, slight variations in QRS complex or T wave configuration occur. To be sure that such differences express the presence of p waves dissociated from QRS complexes, and superimposed on these, it is necessary to measure Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2 the intervals separating the “disturbing” events: in case of A-V dissociation, they are separated from relatively constant intervals, being "long" inEbook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2
tervals in multiples of the "short” ones (Fig. 6. la). When, in contrast, the intervals separating the changes in morphology of T waves and/or QRS comWide QRS Complex Tachycardia in the Emergency Setting6Giuseppe Oreto, Francesco Luzza, Gaetano Satullo, Antonino Donato, Vincenzo Carbone, and Maria P Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2zed, searching for ‘’dissociated" p waves, are leads II and VI. the ones where sinus p wave voltage is usually relatively high: it is also advisable to observe the leads where the ỌRS complex and/or the T wave is of6 Wide QRS Complex Tachycardia in the Emergency Setting91ĂŨẢŨXŨÕ•••• o ••ẠẤUuụụ•• • Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2• • • •Fig. 6.1 Diagrams (a. bl show two wide QRS complex tachycardias. In both diagrams, small positive deflections, independent of ỌRS complexes, arEbook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2
e present. In diagram (a) these deflections are rhythmic and separated by constant intervals; whenever a deflection is invisible, being coincident witWide QRS Complex Tachycardia in the Emergency Setting6Giuseppe Oreto, Francesco Luzza, Gaetano Satullo, Antonino Donato, Vincenzo Carbone, and Maria P Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2ingly. A-V dissociation can be diagnosed, revealing a ventricular origin of tachycardia. In diagram < bl. in contrast, the small positive deflections are arrhythmic: they are not p waves but artifactslow voltage, since it is relatively easy to detect the small atrial waves whenever these are not "bu Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2ried” within large ỌRS or T deflections. This is expressed by the "haystack principle”: if you are searching for a needle in a haystack, select a smalEbook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2
l haystack” (Fig. 6.2).The bedside diagnosis of A-V dissociation can be improved by heart sound auscultation and arterial pulse palpation: whenever thWide QRS Complex Tachycardia in the Emergency Setting6Giuseppe Oreto, Francesco Luzza, Gaetano Satullo, Antonino Donato, Vincenzo Carbone, and Maria P Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2 in peripheral pulse amplitude. This is because (1) whenever atrial contraction occurs immediately before ventricular systole, the blood flow "opens” the atrioventricular valves, resulting in a relatively loud 1st heart sound, a phenomenon that does not occur if mitral and tricuspid valves arc close Ebook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2d al the time of atrial systole, and (2) if atrial contraction occurs when the A-V valves arc open, the diastolic ventricular filling is improved, resEbook The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians: Part 2
ulting in a relatively increased stroke volume: accordingly, the pulse amplitude will be higher with respect to that of heart beats in which atrial syWide QRS Complex Tachycardia in the Emergency Setting6Giuseppe Oreto, Francesco Luzza, Gaetano Satullo, Antonino Donato, Vincenzo Carbone, and Maria PWide QRS Complex Tachycardia in the Emergency Setting6Giuseppe Oreto, Francesco Luzza, Gaetano Satullo, Antonino Donato, Vincenzo Carbone, and Maria PGọi ngay
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