By David Kerr, Annie Young, Richard Hobbs
(BMJ Books) Univ. of Birmingham, united kingdom. Covers key components of sufferer care and offers debate round the a variety of uncertanties concerning the affliction. colour illustrations. Softcover.
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Additional info for ABC of Clinical Electrocardiography
When the tachycardia originates from the posterior fascicle the frontal plane axis of the QRS complex is deviated to the left; when it originates from the anterior fascicle, right axis deviation is seen. Right ventricular outflow tract tachycardia This tachycardia originates from the right ventricular outflow tract, and the impulse spreads inferiorly. The electrocardiogram typically shows right axis deviation, with a left bundle branch block pattern. The tachycardia may be brief and self terminating or sustained, and it may be provoked by catecholamine release, sudden changes in heart rate, and exercise.
During the test the electrocardiogram machine provides a continuous record of the heart rate, and the 12 lead electrocardiogram is recorded intermittently. Blood pressure must be measured before the exercise begins and at the end of each exercise stage. Blood pressure may fall or remain static during the initial stage of exercise. This is the result of an anxious patient relaxing. As the test progresses, however, systolic blood pressure should rise as exercise increases. A level of up to 225 mm Hg is normal in adults, although athletes can have higher levels.
Aberrant conduction usually manifests as left or right bundle branch block, both of which have characteristic features. The bundle branch block may predate the tachycardia, or it may be a rate related functional block, occurring when atrial impulses arrive too rapidly for a bundle branch to conduct normally. When atrial fibrillation occurs with aberrant conduction and a rapid ventricular response, a totally irregular broad complex tachycardia is produced. 16 s x A QS or predominantly negative deflection in lead V6 x Concordance throughout the chest leads, with all deflections negative x An rS complex in lead V1 V6 I Atrial fibrillation and left bundle branch block Wolff-Parkinson-White syndrome Broad complex tachycardias may also occur in the Wolff-Parkinson-White syndrome, either as an antidromic atrioventricular re-entrant tachycardia or in association with atrial flutter or fibrillation.
ABC of Clinical Electrocardiography by David Kerr, Annie Young, Richard Hobbs