Clinical Electrocardiography by B. L. Chia

By B. L. Chia

During this variation, the sections on posterior myocardial infraction, supraventricular tachycardia, ventricular tachycardia, and anti-arrhythmic drug treatment have all been up to date or revised. This publication is the fruits of approximately 30 years of expertise within the educating of electrocardiography to coronary-care-unit nurses, clinical undergraduates, interns, citizens and cardiology registrars. The method of the topic is completely from the perspective of a clinician, therefore theoretical issues were stored to a minimal and clinical-electrocardiographic correlations were emphasised through the textual content.

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I m avt- #I+# EE i T = v1 v2 V6 v5 Fig. 6 mmoVL) in a 23-year-old man with thyrotoxic periodic paralysis who presented with weakness in all 4 limbs. Note: (1) Tall U waves (arrowheads) in multiple leads. In some leads (eg Vz, V3), the U waves are very prominent (4 mm in V3). (2) T wave inversion/ST segment depression in V1 and V2. 21 This normal ECG was recorded from the same patient whose ECG is shown in Fig. 20, at a time when treatment had restored the serum potassium to a normal level. HYPERKALAEMIA The main ECG abnormality in hyperkalaemia is the presence of tall T waves.

The clinical significance of post-extrasystolic T wave changes. Circulation 1952; 6: 358. 13. Engel TR. Postextrasystolic T wave changes and angiographic coronary disease. Br Heart J 1977; 39: 371. ’ In his description, pattern I showed deeply inverted T waves (especially in the praecordial leads) simulating subendocardial infarction (Fig. 1). This pattern is very rare in the normal Asian population. ^ Here, there is elevation of the ST segment, concave upwards. The T wave is tall and asymmetrical with a gently sloped ascending limb and a sharp descending limb ending in a prominent U wave.

A further point of distinction between acute pericarditis and the early repolarization pattern is that the height of the T waves in the former is normal, whereas it is considerably increased in the latter. e. ^ Lastly, in acute pericarditis, there is often depression of the PR segment which is frequently maximal in lead 11. The QRS voltages in patients with acute pericarditis, but without pericardial effusion, are normal. . III I v2 -utcI. -. - . - .. aV L aV R aVF v3 Fig. 3 Acute pericarditis.

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