ABC of Clinical Electrocardiography by David Kerr, Annie Young, Richard Hobbs

By David Kerr, Annie Young, Richard Hobbs

(BMJ Books) Univ. of Birmingham, united kingdom. Covers key components of sufferer care and gives debate round the various uncertanties concerning the disorder. colour illustrations. Softcover.

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Polymorphic ventricular tachycardia must be differentiated from atrial fibrillation with pre-excitation, as both have the appearance of an irregular broad complex tachycardia with variable QRS morphology (see last week’s article). Causes of torsades de pointes Drugs x Antiarrhythmic drugs: class Ia (disopyramide, procainamide, quinidine); class III (amiodarone, bretylium, sotalol) x Antibacterials: erythromycin, fluoquinolones, trimethoprim x Other drugs: terfenadine, cisapride, tricyclic antidepressants, haloperidol, lithium, phenothiazines, chloroquine, thioridazine Electrolyte disturbances x Hypokalaemia x Hypomagnesaemia Congenital syndromes x Jervell and Lange-Nielsen syndrome x Romano-Ward syndrome Other causes x Ischaemic heart disease x Myxoedema x Bradycardia due to sick sinus syndrome or complete heart block x Subarachnoid haemorrhage Polymorphic ventricular tachycardia deteriorating into ventricular fibrillation Broad complex tachycardias of supraventricular origin In the presence of aberrant conduction or ventricular pre-excitation, any supraventricular tachycardia may present as a broad complex tachycardia and mimic ventricular tachycardia.

By transiently slowing or blocking conduction through the atrioventricular node, an atrioventricular nodal re-entrant tachycardia or atrioventricular re-entrant tachycardia may be terminated. In atrial flutter transient block may reveal the underlying flutter waves. 28 Adenosine can also be used to block conduction temporarily through the atrioventricular node to ascertain the origin of a broad complex tachycardia, but failure to stop the tachycardia does not necessarily indicate a ventricular origin 8 Acute myocardial infarction—Part I Francis Morris, William J Brady In the clinical assessment of chest pain, electrocardiography is an essential adjunct to the clinical history and physical examination.

Torsades de pointes is not usually sustained, but it will recur unless the underlying cause is corrected. Occasionally it may be prolonged or degenerate into ventricular fibrillation. It is associated with conditions that prolong the QT interval. Transient prolongation of the QT interval is often seen in the acute phase of myocardial infarction, and this may lead to Fascicular ventricular tachycardia (note the right bundle branch block pattern and left axis deviation) I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 Right ventricular outflow track tachycardia Torsades de pointes may be drug induced or secondary to electrolyte disturbances Torsades de pointes 25 ABC of Clinical Electrocardiography torsades de pointes.

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