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ABC of clinical electrocardiography by Francis Morris; William Brady; A John Camm

By Francis Morris; William Brady; A John Camm

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8 Capture beat. 9 Fusion beat. Fusion beats A fusion beat occurs when a sinus beat conducts to the ventricles via the atrioventricular node and fuses with a beat arising in the ventricles. As the ventricles are depolarised partly by the impulse conducted through the His-Purkinje system and partly by the impulse arising in the ventricle, the resulting QRS complex has an appearance intermediate between a normal beat and a tachycardia beat. Like capture beats, fusion beats are uncommon, and though they support a diagnosis of ventricular tachycardia, their absence does not exclude the diagnosis.

It is unusual for ST segment elevation in lead V1 to occur as an isolated phenomenon. Right sided chest leads are much more sensitive to the presence of right ventricular infarction. The most useful lead is lead V4R (an electrode is placed over the right fifth intercostal space in the midclavicular line). Lead V4R should be recorded as soon as possible 2/7/2008 12:02:42 PM Acute Myocardial Infarction—Part I 35 in all patients with inferior infarction, as ST segment elevation in right ventricular infarction may be short lived.

16 s. 2 s, particularly if the patient has electrolyte abnormalities or severe myocardial disease or is taking antiarrhythmic drugs, such as flecainide. 14 s. The QRS complex in ventricular tachycardia often has a right or left bundle branch morphology. In general, a tachycardia originating in the left ventricle produces a right bundle branch block pattern, whereas a tachycardia originating in the right ventricle results in a left bundle branch block pattern. The intraventricular septum is the focus of the arrhythmia in some patients with ischaemic heart disease, and the resulting complexes have a left bundle branch block morphology.

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