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MEDICINE HURST VENTRICULAR ELECTROCARDIOGRAPHY - Part 9

Huyết áp tâm thu máu của ông là 170mmHg và huyết áp tâm trương là 60mmHg. Arteriogram vành tiết lộ tắc nghẽn 90% của phía trước bên trái động mạch vành gần đến chi nhánh đầu tiên của nó, và tổn thương ngoại biên để các chi nhánh đầu tiên giảm dần. | 225 Figure 11.18 This electrocardiogram showing anteroseptal infarction and left ventricular hypertrophy was recorded from an 80-year-old man. The patient had congestive heart failure and experienced angina pectoris at rest. His systolic blood pressure was 170mmHg and his diastolic blood pressure was 60mmHg. The coronary arteriogram revealed 90 obstruction of the left anterior descending coronary artery proximal to its first branch and three lesions distal to the first branch. They constituted 50 40 and 30 reductions in luminal diameter respectively. There was a 40 obstruction in the first diagonal branch a minor lesion in the left circumflex coronary artery and 70 obstruction of the first marginal coronary artery. The left ventricular diastolic pressure was 20mmHg and the ejection fraction was 36 . The anterior and apical areas of the left ventricle were akinetic and the inferior wall was hypokinetic. The heart rhythm is normal and the heart rate is 64 complexes per minute. The duration of the PR interval is 0.20 second. The duration of the QRS complex is 0.08 second and the duration of the QT interval is 0.35 second. P waves The P waves are normal. QRS complex The mean QRS vector is directed at 0 in the frontal plane and 45 to 60 posteriorly. The mean initial 0.04-second QRS vector is directed about 50 inferiorly and about 45 posteriorly. The mean initial 0.01-second QRS vector is directed about 50 inferiorly and about 45 posteriorly but the mean initial 0.02-second vector is directed about 50 inferiorly and about 30 posteriorly. This produces a notch on the S wave in lead V1 and a small Q wave followed by an R and then an S wave in leads V2 and V3. It identifies an initial abnormality of the QRS loop and serves to emphasize that a Q wave need not be 0.04-second wide to signify infarction. The 12-lead QRS amplitude is greater than 180mm suggesting the presence of left ventricular hypertrophy. ST segment The mean ST vector is directed 120 inferiorly and about 20 .