By Francis Morris; William Brady; A John Camm
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Additional resources for ABC of clinical electrocardiography
12 s or longer). 16 s. 2 s, particularly if the patient has electrolyte abnormalities or severe myocardial disease or is taking antiarrhythmic drugs, such as flecainide. 14 s. The QRS complex in ventricular tachycardia often has a right or left bundle branch morphology. In general, a tachycardia originating in the left ventricle produces a right bundle branch block pattern, whereas a tachycardia originating in the right ventricle results in a left bundle branch block pattern. The intraventricular septum is the focus of the arrhythmia in some patients with ischaemic heart disease, and the resulting complexes have a left bundle branch block morphology.
Patients may first present when they are old. When rapid arrhythmias occur in association with atrial fibrillation, patients may present with heart failure or hypotension. indd 22 that block the atrioventricular node—for example, digoxin, verapamil, and adenosine—may be dangerous in this situation and should be avoided. These drugs decrease the refractoriness of accessory connections and increase the frequency of conduction, resulting in a rapid ventricular response, which may precipitate ventricular fibrillation.
On the standard 12 lead electrocardiogram right ventricular infarction is indicated by signs of inferior infarction, associated with ST segment elevation in lead V1. It is unusual for ST segment elevation in lead V1 to occur as an isolated phenomenon. Right sided chest leads are much more sensitive to the presence of right ventricular infarction. The most useful lead is lead V4R (an electrode is placed over the right fifth intercostal space in the midclavicular line). Lead V4R should be recorded as soon as possible 2/7/2008 12:02:42 PM Acute Myocardial Infarction—Part I 35 in all patients with inferior infarction, as ST segment elevation in right ventricular infarction may be short lived.
ABC of clinical electrocardiography by Francis Morris; William Brady; A John Camm