Compare the Old and New ECG: Difference between revisions

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* Is there a [[#frequentieverandering| change in frequency]]?
* Is there a [[#frequentieverandering| change in frequency]]?
* Is there a change in [[#Geleidingstijden|conduction time]]?
* Is there a change in [[#Geleidingstijden|conduction time]]?
* Is there a change in [[#Hartas|cardiac axe]]?
* Is there a change in [[#Hartas|heart axis]]?
* Are there new [[#Pathologische Q's|pathological Q's]]?
* Are there new [[#Pathologische Q's|pathological Q's]]?
* Is there a change in [[#R top hoogte|R wave size]]?
* Is there a change in [[#R top hoogte|R wave size]]?
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An increase in PQ time may be seen in elderly patients, but may also be caused by the use of medication or by ischemia. Broadening of the QRS complex may be caused by medication or ischemia. An increase in QTc time may be caused by medication, but may also be heridetary. Comparison of previous made ECG registration with new registration may provide the clue.
An increase in PQ time may be seen in elderly patients, but may also be caused by the use of medication or by ischemia. Broadening of the QRS complex may be caused by medication or ischemia. An increase in QTc time may be caused by medication, but may also be heridetary. Comparison of previous made ECG registration with new registration may provide the clue.


==Hart axes==
==Heart axis==
Ischemia may cause a change in the cardiac axe, however also heridetary differences in hart axes may occur. Again, a previous ECG differentiates between old and new changes.
Ischemia may cause a change in the heart axis, however also heridetary differences in heart axis may occur. Again, a previous ECG differentiates between old and new changes.


==Pathologische Q's==
==Pathologische Q's==

Revision as of 17:38, 28 May 2007

An abnormal ECG does not prove acute cardiac disease. And a normal ECG does not exclude cardiac disease. It is necessary therefore to compare new ECG with ECG's made in the past.

Hallmarks are:

So, one have to check for changes in all 7 steps.

Change in rhythm

Example: new atrial fibrillation. Atrial fibrillation occurs in ten percent of elderly people (>70 year) without clinical symptoms. Therefore atrial fibrillation in acute dyspnoic patients does not prove atrial fibrillation induced cardiac decompensation. Also other causes (e.g. cardiac ischemia, pneumonia) should be considered. Previous ECG registrations could provide additional information.

Frequency

Example: bradycardia. New sinusbradycardia of 50 beats per minute (bpm) may cause dizziness, however, long existing bradycardias are often without symptoms. Therefore it is important to know about someones normal frequency.

Conduction time

An increase in PQ time may be seen in elderly patients, but may also be caused by the use of medication or by ischemia. Broadening of the QRS complex may be caused by medication or ischemia. An increase in QTc time may be caused by medication, but may also be heridetary. Comparison of previous made ECG registration with new registration may provide the clue.

Heart axis

Ischemia may cause a change in the heart axis, however also heridetary differences in heart axis may occur. Again, a previous ECG differentiates between old and new changes.

Pathologische Q's

Dit is een van de belangrijkste verschillen om naar te kijken. Nieuwe pathologische Q's ten opzichte van een oud ECG, tonen aan dat er in de tussentijd een hartinfarct heeft plaatsgevonden.

R top hoogte

Afname van de R top hoogte kan teken zijn van een infarct in de tussentijd. Tamponade, cardiomyopathie en toegenomen lichaamsomvang zijn andere opties.

Toename van R top hoogte past bij linkerventrikel hypertrofie (met name V5-V6), of een posteriorinfarct (V2-V3). Gewichtsverlies (ECG plakkers dichter op het hart)

ST segmenten

Nieuwe ST-elevatie past in eerste instantie bij een acuut myocardinfarct. ST-elevatie kan ook chronisch aanwezig zijn bij een aneurysma cordis en enkele weken aanwezig zijn bij een pericarditis.

T toppen

T top inversie heeft veel mogelijke oorzaken. Ischemie, electrolytenstoornissen maar ook stress is een optie. Het is meestal niet specifiek genoeg om hier een onderscheid tussen te maken. T top inversie is dus meer een teken dat er 'iets' aan de hand is. Nader onderzoek (vervolg-ECG's, laboratoriumonderzoek) kan uitwijzen wat dat dan is.