By David Adlam, John R. Hampton DM MA DPhil FRCP FFPM FESC, Jo Hampton
Wow, do not cross pass eyed but when it's a trend acceptance ECG e-book you would like, this is often it, you'll have to learn the spouse ECG made effortless first - or purchase them jointly.
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Additional info for 150 ECG Problems
ANSWER 24 The ECG shows: • • • • • the patient will need an angiotensin-converting enzyme inhibitor, a diuretic and, probably, anticoagulants. Beta-blockers must be considered once his cardiac failure is controlled. Atrial fibrillation Ventricular rate 75-200/min Normal axis Normal QRS complexes Downward-sloping ST segment depression, especially in leads V5, V6 Clinical interpretation The ventricular rate is not adequately controlled, though the ST segment depression suggests that he is taking digoxin.
Echocardiography is necessary. The serum digoxin level must be checked and the digoxin dose increased if appropriate. In addition to digoxin, Summary ** Atrial fibrillation with an uncontrolled ventricular rate, and digoxin effect. fif] See pp. 78 and 107 IP I See p. 315 1 rn 73 ro ^ A 60-year-old man, who 3 years earlier had had a myocardial infarction followed by mild angina, was admitted to hospital with central chest pain that had been present for 1 h and had not responded to sublingual nitrates.
______ ^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.
150 ECG Problems by David Adlam, John R. Hampton DM MA DPhil FRCP FFPM FESC, Jo Hampton