By Francis Morris; William Brady; A John Camm
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Extra info for ABC of clinical electrocardiography
Biphasic T wave changes usually evolve and are often followed by symmetrical T wave inversion. These changes occur in patients with unstable or crescendo angina and strongly suggest myocardial ischaemia. 1 Suggested criteria for size of T wave. 2 T wave inversion. 5 Biphasic T waves in man aged 26 with unstable angina. 2/7/2008 12:04:06 PM Myocardial Ischaemia 43 ST segment depression Typically, myocardial ischaemia gives rise to ST segment depression. The normal ST segment usually blends with the T wave smoothly, making it difficult to determine where the ST segment ends and the T wave starts.
1 Mechanism of atrioventricular nodal re-entrant tachycardia showing the slow and fast conduction routes and the ﬁnal common pathway through the lower part of the atrioventricular node and bundle of His. 2 A premature atrial impulse ﬁnds the fast pathway refractory, allowing conduction only down the slow pathway (left). By the time the impulse reaches the His bundle, the fast pathway may have recovered, allowing retrograde conduction back up to the atria—the resultant “circus movement” gives rise to slow-fast atrioventricular nodal re-entrant tachycardia (right).
V2R V6R V5R V1R Posterior myocardial infarction Posterior myocardial infarction refers to infarction of the posterobasal wall of the left ventricle. The diagnosis is often missed as the standard 12 lead electrocardiography does not include posterior leads. Early detection is important as expeditious thrombolytic treatment may improve the outcome for patients with posterior infarction. The changes of posterior myocardial infarction are seen indirectly in the anterior precordial leads. Leads V1 to V3 face the endocardial surface of the posterior wall of the left ventricle.
ABC of clinical electrocardiography by Francis Morris; William Brady; A John Camm