By David Kerr, Annie Young, Richard Hobbs
(BMJ Books) Univ. of Birmingham, united kingdom. Covers key components of sufferer care and offers debate round the various uncertanties concerning the illness. colour illustrations. Softcover.
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Additional resources for ABC of Clinical Electrocardiography
The normal ST segment usually blends with the T wave smoothly, making it difficult to determine where the ST segment ends and the T wave starts. One of the first and most subtle changes in the ST segment is flattening of the segment, resulting in a more obvious angle between the ST segment and T wave. A C Subtle ST segment change in patient with ischaemic chest pain: when no pain is present (top) and when in pain (bottom) 38 B D ST changes with ischaemia showing normal wave form (A); flattening of ST segment (B), making T wave more obvious; horizontal (planar) ST segment depression (C); and downsloping ST segment depression (D) Substantial ST segment depression in patient with ischaemic chest pain Myocardial ischaemia More obvious changes comprise ST segment depression that is usually planar (horizontal) or downsloping.
Atrial fibrillation In patients without an accessory pathway the atrioventricular node protects the ventricles from the rapid atrial activity that occurs during atrial fibrillation. In the Wolff-Parkinson-White syndrome the atrial impulses are conducted down the accessory pathway, which may allow rapid conduction and consequently very fast ventricular rates. The impulses conducted via the accessory pathway produce broad QRS complexes. Occasionally an impulse will be conducted via the atrioventricular node and produce a normal QRS complex or a fusion beat.
Atrioventricular block may be severe at first but usually improves over subsequent days. Complete atrioventricular block usually gives way to second degree and then first degree block. Although temporary transvenous cardiac pacing may be necessary for patients who are haemodynamically compromised, it is not mandatory in stable patients. Acute myocardial infarction with complete heart block Profound bradycardia or atrioventricular block resulting from ischaemia may provoke an escape rhythm. Such rhythms are the result of spontaneous activity from a subsidiary pacemaker located within the atria, atrioventricular junction, or ventricles.