Answers example 1 question 1: Difference between revisions

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Antwoorden en onderaan het vervolg van de casus!
{{Case|
|previouspage= Cases_and_Examples
|previousname= Return to Cases and Examples
|nextpage= Case 2
|nextname= Case 2}}


* Beschrijf het ECG volgens het 7 + 2 stappenplan
Answers and below the case will continue!
**Ritme
* Describe the ECG according the 7 + 2 step plan
***'''Het is een regulair ritme en ieder QRS complex wordt voorafgegaan door een p-top. De p top is positief in II,III en AVF en komt dus vanuit de sinusknoop. Conclusie: sinusritme.'''
**Rhythm
**Hartfrequentie.  
***'''This is a regular rhythm and every QRS complex has a P-wave in front of it. The P wave us positive in II, III and AVF and comes from the sinusnode. So it's a sinusrhythm.'''
***'''Gebruik de 'telmethode' (3 grote hokjes ~> 300-150-100), dus 100/min.'''
**Heartrate.  
**Geleidingstijden (PQ,QRS,QT)  
***'''Use the 'counting methode' (3 large grids ~> 300-150-100), so 100/min.'''
***'''PQ-tijd=0.16sec (4 kleine hokjes), QRS duur=0.10sec, QT tijd=280ms, QTc tijd=361 ms'''
**Conductiontimes (PQ,QRS,QT)  
**Hartas
***'''PQ-time=0.16sec (4 small grids), QRS duration=0.10sec, QT time=280ms, QTc interval=361 ms'''
***'''Isoelectrisch in I, positief in II,III en AVF. Dus een verticale hartas.'''
**Heart axis
**P top morfologie
***'''Isoelectric in I, positive in II, III and AVF. Therefore it is a vertical heartaxis.'''
***'''De p top is mogelijk > 2,5 mm in II (niet goed te zien want daar zit geen mm verdeling), dus er zou sprake kunnen zijn van rechteratrium belasting.'''
**P wave morphology
**QRS morfologie
***'''The p wave is possibly > 2,5 mm in II (hard to see, a good millimetergrid is lacking), so there could be right atrium overload.'''
***'''Pathologische Q in AVL, V1-V3 en mogelijk V4-5 (veel storing). Nauwelijks R top progressie over de voorwand.'''
**QRS morphology
**ST morfologie
***'''Pathologic Q in AVL, V1-V3 and possibly V4-5 (poor quality). Hardly any precordial R-wave progression.'''
***'''Forse ST elevatie in V2-V5 en ook in I,AVL.'''
**ST morphology
**vergelijking met het oude ECG (niet voor handen, dus overslaan)
***'''ST elevation in V2-V5 and in I,AVL.'''
**conclusie. Wat is er aan de hand?
**No prior ECG to compare
**Conclusion. What's going on?




'''Antwoord: Een groot voorwandinfarct
'''Answer: A large anterior wall infraction


Toevoegingen: met mogelijk rechter atriumbelasting door backwardfailure van de linker hartkamer.
Additions: and possibly right atriumoverload caused by backwardfailure of the left ventricle.


 
[[Image:casus1_1.jpg|thumb|left| ECG on admission]]
[[Image:casus1_1.jpg|thumb|left| ECG bij binnenkomst]]
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[[Continue example 1]]
[[Continue example 1]]

Latest revision as of 15:04, 11 November 2008

This page is part of Cases and Examples

Previous ECG: Return to Cases and Examples | Next ECG: Case 2

Answers and below the case will continue!

  • Describe the ECG according the 7 + 2 step plan
    • Rhythm
      • This is a regular rhythm and every QRS complex has a P-wave in front of it. The P wave us positive in II, III and AVF and comes from the sinusnode. So it's a sinusrhythm.
    • Heartrate.
      • Use the 'counting methode' (3 large grids ~> 300-150-100), so 100/min.
    • Conductiontimes (PQ,QRS,QT)
      • PQ-time=0.16sec (4 small grids), QRS duration=0.10sec, QT time=280ms, QTc interval=361 ms
    • Heart axis
      • Isoelectric in I, positive in II, III and AVF. Therefore it is a vertical heartaxis.
    • P wave morphology
      • The p wave is possibly > 2,5 mm in II (hard to see, a good millimetergrid is lacking), so there could be right atrium overload.
    • QRS morphology
      • Pathologic Q in AVL, V1-V3 and possibly V4-5 (poor quality). Hardly any precordial R-wave progression.
    • ST morphology
      • ST elevation in V2-V5 and in I,AVL.
    • No prior ECG to compare
    • Conclusion. What's going on?


Answer: A large anterior wall infraction

Additions: and possibly right atriumoverload caused by backwardfailure of the left ventricle.

ECG on admission


Continue example 1

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