Case 100: Difference between revisions

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m (New page: Look at the consecutive ECGs in this patient. What is the problem? thumb|300px|left| ECG1 {{clr}} thumb|300px|left| ECG2 {{clr}}...)
 
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Look at the consecutive ECGs in this patient. What is the problem?
Look at the consecutive ECGs in this patient. What is the problem?
[[Afbeelding:KJcasu17-1.jpg|thumb|300px|left| ECG1]]
[[Image:KJcasu17-1.jpg|thumb|300px|left| Rhythm strip 1]]
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[[Afbeelding:KJcasu17-2.jpg|thumb|300px|left| ECG2]]
[[Image:KJcasu17-2.jpg|thumb|300px|left| Rhythm strip 2]]
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[[Afbeelding:KJcasu17-3.jpg|thumb|300px|left| ECG3]]
[[Image:KJcasu17-3.jpg|thumb|300px|left| Rhythm strip 3]]
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[[Afbeelding:KJcasu17-4.jpg|thumb|300px|left| ECG4]]
[[Image:KJcasu17-4.jpg|thumb|300px|left| Rhythm strip 4]]
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* Following the 7+2 steps:
==Answer==
**Rhythm
* The first rhythm strip shows sinusrhythm with a severely prolonged QT interval. In total four ventricular premature beats are present on this strip. All fall within the T wave of the previous sinus beat.
***'''The ECG shows a regular rhythm. Every P wave is followed by a QRS complex. P waves are positive in I and AVF. Normal sinus rhythm'''
* The second strip shows [[Torsade de Pointes]] with a typical short (not shown) - long - short initial sequence.
**Heart rate
* The
***'''40 bpm'''
**Conduction (PQ,QRS,QT)
***'''PQ: 160ms QRS: 90ms QT: 420ms QTc: 360ms
**Heartaxis
***'''QRS positive in I and AVF: normal heart axis'''
**P wave morphology
***'''Normal P wave morphology'''
**QRS morphology
***'''Pathologic Q waves in III and AVF. QS in V1 and V2. No ST elevation in V3 (=V4R). '''
**ST morphology
***'''ST elevation in II, III, AVF and V5. ST depression in I, AVL.'''
**Compare with the old ECG (not available, so skip this step)
**Conclusion?
 
 
'''sinusbradycardia with inferior-lateral myocardial infarction.'''


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Revision as of 21:35, 28 November 2007

Look at the consecutive ECGs in this patient. What is the problem?

Rhythm strip 1


Rhythm strip 2


Rhythm strip 3


Rhythm strip 4


Answer

  • The first rhythm strip shows sinusrhythm with a severely prolonged QT interval. In total four ventricular premature beats are present on this strip. All fall within the T wave of the previous sinus beat.
  • The second strip shows Torsade de Pointes with a typical short (not shown) - long - short initial sequence.
  • The