漂亮蓝色流线型模板ECG OF THE WEEK.pptxVIP

ECG OF THE WEEKDR.P.VIJAYARAGHAVAN’S UNIT DR.C.R.RAJAKUMAR65 YRS old male came OPD C/O shortness of breath, palpitationKnown DM,SHT on regular treatmentO/E Pts GC fairPulse - 94/min, irregularly irregularBP- 100/70 mmHgCVS - S1S2 Heard ,no murmursRS - NVBS , no added soundsP/A – Soft, no organomegalyCNS- NFND ;Rate- 100/minAxis lt axis -30 sinus beat interspersed with broad QRS complexesSINUS BEAT; P-wave predominently negative component in V1PR interval-0.16 secondsQRS duration 0.12 secondsST depression T –inversion in L1,AVL,V5-V6Tall R wave in V5-V6[20mm]BROAD QRS COMPLEXES BROAD ,BIZZARE COMPLEXES[0.16 SECS]Varying morphologyRBBB PatternConstant coupling interval for most of the complexesNo compensatory pauseSecondary ST-T changes presentINFERENCE;LAE [lt atrial enlargement]LVH [Lt ventricular enlargement]VPC[ventricular pre mature complexes]Possible site of origin [lt ventricle] MultifocalInterpolated VPCTRIPLETSVPC [ventricular pre mature complexes]Characterized by the pre mature occurance of a QRS complex that is abnormal in shape and has a duration usually exceeding the dominent QRS complex generally 120 millisecondsT wave is commonly large and opposite in direction to the major deflexion of the QRSFully compensatory pause usually follows a VPCInterval between the P wave of the sinus impulse immediately before the vpc and the first sinus p wave after the vpc equal to twice of the sinus cycle length VPC MAY OCCURBigeminy-every sinus beat is followed by a VPCTrigeminy-every 2 sinus beats are followed by a VPCQuatrigeminy-every 3 sinus beats followed by a VPC 2 successivevpcs- COUPLET or PAIR 3 successive vpcs- TRIPLETINTERPOLATED VPC-is an extra systole which is, so to speak ,sandwiched between two conducted sinus beats3-5 consecutive impulse - SALVOS3 or more successive vpc s at a rate of 120 or more lasting 30 seconds or more -