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Basic Electrocardiography Normal and abnormal ECG patterns - Part 10

Đây là một nhồi máu bên điển hình. Một hình thái RS 0,5 là quan sát V1 dẫn với một làn sóng đối xứng T tích cực, không có sóng Q dẫn kém, nhưng với một làn sóng Q rõ ràng dẫn của lưng (V7-V9). Trong trường hợp này, mối tương quan với các kỹ thuật hình ảnh, đặc biệt là hạt nhân cộng hưởng từ (MRI) | 156 Self-assessment Answer to Case 18 Comment. This is a typical lateral infarction. An RS morphology 0.5 is observed in lead VI with a symmetric positive T wave with no Q wave in the inferior leads but with an apparent Q wave in the leads of the back V7-V9 . In thiscase the correlation with the imaging techniques especially the nuclear magnetic resonance smaging MRI with gadolinium enhancement shows that there is generally a lateral wall involvement mainly segments 5 and 11. Generally the occluded artery is the oblique marginal coronary artery or for short LCX. Due to the heart walls location within the thorax in the cases of lateral involvement the vector of necrosis faces viand may be seen as RS morphology in this lead.Theleads located on the back aid in the diagnosis qr morphology . Therefore the correct answer is c see Figure 59 and Table 16 . Self-assessment 157 Case 19 This is an asymptomatic 35-year-old patient with no abnormal findings on physical examination. In your opinion which is the diagnosis A Severe aortic stenosis B Hypertrophic cardiomyopathy c Athlete D Ischaemic heart disease 158 Self-assessment Answer to Case 19 Comment. The ECG shows large QRS voltage in the left-sided leads with a tall R wave so the diagnosis of LVE is evident. However this is not the typical ECG recording of a patient with a severe aortic stenosis there is a clear negative T wave starting in V2 onwards nor a patient with ischaemic heart disease too many negativeasymmetric Twaves in an asymptomatic patient . The recording is suggestive of a hypertrophic cardiomyopathy with apical predominance even though ECGs with these characteristics have been recorded in athletes with no hypertrophic cardiomyopathy. This patient is not an athlete and the echocardiography shows the presence septum of 18 mm of a non-obstructive hypertrophicccrdiomyopathy. Therefore the correct answer is B see p. 117