Ecg hampton pdf

Provides a full understanding of the ECG in the diagnosis and management of abnormal cardiac rhythms. Emphasises the role of the full 12 lead ECG with realistic reproduction of recordings. The unique page size allows presentation of lead ECGs across a single page for clarity.

The second part explains the theory underpinning the recording of an ECG in order to start basic interpretation of the 12 leads.

The third part looks at the clinical interpretation of individual ECGs in patients with chest pain, breathlessness, palpitations and syncope as well as understanding the normal variations in ECGs recorded from healthy subjects.

ECG es normal. El cuadro 2. Los ECG de las figuras 2. El ECG de la figura 2. ECG de reposo puede ser de gran utilidad, como se re- sume en la tabla 2. En cualquiera de esos casos se evita el mente hacia delante por una rama y bloquearse en la retraso nodal auriculoventricular AV normal, de for- otra.

A partir del punto en el que se unen ambas ramas, ma que el intervalo PR es corto. Este intervalo QT cardio posterior v. La figura 2. No existe un umbral absoluto de riesgo. Sin embargo, el ciente. Sin embargo, debe recordarse que los tras- completo. En la figura 2. Los bloqueos de «escape». Si el hemibloqueo anterior izquierdo se asocia a un bloqueo de primer grado y a un BRI fig. El ECG de un paciente con una arritmia sinusal fig. Otras causas se resu- Taquicardia sinusal men en el cuadro 1.

Las causas posibles de bradi- cardia sinusal se enumeran en el cuadro 1. No existen ondas P fig. Los tipos de taquicardias de complejo estrecho se enu- meran en el cuadro 2. A veces se encuentran ocultas de lpm en la onda T del latido previo. En este ritmo no pue- den observarse ondas P. Cuadro 2. Los complejos anchos pueden deberse a bloqueo de rama, o a ritmos ventriculares.

No es posible distinguir entre ritmos supra- cardia ventricular TV. Cualquier tipo de ritmo puede tolerarse bien y meran en el cuadro 2. Sin embargo, las taquicardias de comple- complejo ancho solo puede diagnosticarse con certeza jo ancho que aparecen durante un infarto agudo de mio- Fig. Otras causas de taquicardia ventricular se exponen en el cuadro 2.

La presencia de ondas P. Si la frecuencia de las on- Una taquicardia irregular con complejo ancho es das P es menor que la de los complejos QRS, debe probable que sea: tratarse de una TV.

La regularidad de los complejos QRS. La TV suele ser regular. Una taquicardia irregular de complejos Cuadro 2. El cambio del eje indica con firmeza el origen ventricular del ritmo. El latido es- lar durante un episodio de TV fig. Las figuras 2. En este caso la causa fue la tioridazina v.

Como suelen asociarse las Cuadro 2. En un registro ambulatorio fig. La tabla 2. Las arritmias se precipitan en ocasiones por el esfuerzo 2. Pruebas sencillas: fig. Sin embargo, los intentos de provocar una nusal. Si el paciente refiere tener crisis sincopales, sobre 3. Puede que se in- 4. Debe recordar- 1. Existe una causa evidente de la arritmia? Desfibrilar con J. Dos minutos de RCP.

Si no tiene efecto, desfibrilar con J. Si no tiene efecto, administrar 1 mg i. AESP 8. Administrar 1 mg i. En la FV refractaria, administrar 2 g i. Si el un flutter auricular en ritmo sinusal. The ECG is a basic and valuable tool in the investigation of cardiac problems, and it can be helpful in the case of non-cardiac problems too, but it must always be viewed in the context of the patient from whom the record came.

The ECG must never be a substitute for taking a proper medical history and carrying out a careful physical examination. Because it is simple, harmless and cheap, the ECG is usually the first investigation in a patient with possible cardiac disease and it may be followed by the plain chest X-ray, the echocardiogram, radionuclide studies, CT and MR imaging, and cardiac catheterization and angiography — but none of these are substitutes.

The ECG, a recording of the electrical activity of the heart, gives information that can be obtained in no other way. However, even though it is irreplaceable, it is not infallible. ECGs are recorded from a wide variety of patients, in an attempt to help with a wide variety of possible diagnoses.

It can not be assumed that individuals who present themselves for screening are asymptomatic — the process may be being used as a substitute for a consultation with a doctor. The ECG itself may cause difficulties of interpretation, for there are a dozen or more normal variants. Minor abnormalities, such as nonspecific ST segment or T wave changes, will have diagnostic and prognostic significance if the individual has symptoms that may be cardiac in origin, but these changes can be of no importance in totally healthy people.

It is rare for an ECG to demonstrate anything of importance in a totally healthy individual, although in athletes the detection of abnormalities suggesting asymptomatic hypertrophic cardiomyopathy is important. In patients with chest pain, the ECG is important but sometimes misleading.

It is essential to remember that the ECG can remain normal for some hours after the onset of a myocardial infarction. Under such circumstances the ECG should be repeated several times to see if changes are appearing, and patient management should depend on the plasma troponin level rather than on the ECG.

Nevertheless the ECG is important for deciding treatment in a patient with chest pain, for the management of a patient with myocardial infarction with ST segment elevation is quite different from that of a patient whose ECG shows a non-ST segment elevation infarction. Patients with intermittent chest pain that could be angina frequently have completely normal ECGs at rest — and then the exercise test can be valuable.

The exercise test is to some extent being replaced by myocardial perfusion scanning for the diagnosis of coronary disease because its predictive accuracy depends on the likelihood of the patient having angina, because there can be false negative or false positive results, and because exercise tests are sometimes unreliable in women.

Remember that an exercise est is safe, but not totally safe, because arrhythmias including ventricular fibrillation may be induced. The ECG also has a role in the investigation of patients with breathlessness, for it can show changes associated with heart disease e. Evidence of left ventricular hypertrophy may point to hypertension, mitral regurgitation or aortic stenosis or regurgitation, and right ventricular hypertrophy may be the result of pulmonary emboli or mitral stenosis — however, all of these should have been detected during the examination of the patient.

The ECG is not a good tool for grading the hypertrophy of the different heart chambers. It is particularly important to remember that the ECG cannot demonstrate heart failure: it may suggest a condition that may cause heart failure, but is impossible to determine from an ECG whether a patient is in heart failure or not.