By David Adlam, John R. Hampton DM MA DPhil FRCP FFPM FESC, Jo Hampton

ISBN-10: 0443072493

ISBN-13: 9780443072499

Wow, do not move pass eyed but when it's a development attractiveness ECG publication you would like, this can be it, you'll have to learn the spouse ECG made effortless first - or purchase them jointly.

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______ ^23^0 A 90-year-old woman is admitted to hospital after a fall resulting in a fractured hip. On questioning she admits to breathless and 'dizzy turns' for several months. This is her preoperative ECG. What does it show and what would you do? ANSWER 12 The ECG shows: • Second degree (2:1) heart block • Prolonged PR interval (440 ms) in the conducted beats • Ventricular rate about 40/min • Normal QRS complexes and T waves Clinical interpretation Although the slow ventricular response raises the possibility of complete heart block, the fact that the PR interval is constant (albeit prolonged) shows that this is actually second degree block.

Second degree block explains why the QRS complexes are narrow and the T waves are normal. infarction, it is unlikely that this conduction disturbance is new. She therefore needs a permanent pacemaker: the only problem is to decide whether the urgent hip surgery should be covered with a temporary pacemaker - ideally she would be saved that procedure and a permanent system implanted immediately. Summary Second degree (2:1) heart block. What to do Since this woman has been breathless and dizzy for some time, and since there is nothing in the history or on the ECG to suggest an acute IE | See p.

After anticoagulation, cardioversion, either electrical or with flecainide, will be necessary. Clinical interpretation This ECG shows atrial flutter with 2:1 block. The left axis may be due to left anterior hemiblock, although the QRS has a normal duration so the significance of the axis is uncertain. The persistent S wave in lead V6 suggests chronic lung disease. What to do Provided the patient is not in heart failure it is always a good idea to identify the cause of an arrhythmia before treating it.

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150 ECG Problems by David Adlam, John R. Hampton DM MA DPhil FRCP FFPM FESC, Jo Hampton

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