#16
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Åùå êàðòèíêè
Åñëè íå çàãðóçèëîñü êèíî.
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#17
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ÝÊÃ ¹1
Íà ÝÊà àðèòìîãåííàÿ äèñïëàçèÿ ïðàâîãî æåëóäî÷êà.
Èíôîðìàöèÿ Medscape Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a primary disease of heart muscle that results in fibrofatty replacement of the right ventricle and the subepicardial region of the left ventricle. Patients are at high risk for ventricular tachyarrhythmias and sudden death. Epidemiology The prevalence of arrhythmogenic right ventricular cardiomyopathy (ARVC) has been estimated at 1:2500 to 1:5000. In series of sudden cardiac death, this condition represents the cause of 2-5% of deaths in young adults, with higher incidences in exertional deaths Prognosis Young age, a family history of juvenile sudden death, QRS dispersion greater than or equal to 40 ms, T-wave inversion, left ventricular involvement, ventricular tachycardia, syncope, and previous cardiac arrest are the major risk factors for adverse prognosis. ECG According to the revised task force criteria, major ECG criteria include the following: - Inverted T waves in right precordial leads (V1 -V3) or beyond in individuals older than 14 years in the absence of complete right bundle branch block (RBBB); this feature is seen in 87% of patients with ARVD - Epsilon waves (low-amplitude signals between end of QRS complex to the onset of T wave) in leads V1 -V3; these are seen in 33% of patients with ARVD Minor ECG criteria include the following: - Inverted T waves in leads V1 and V2 in individuals older than 14 years in the absence of complete RBBB or in V4, V5, or V6 - Terminal activation of QRS =55 ms measured from the nadir of the S wave to the end of the QRS, including R', in V1, V2, or V3, in the absence of complete RBBB. Ventricular ectopics, when present, have a LBBB configuration. |
#18
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ÝÊÃ-ïðèçíàêè ÀÄÏÆ
Íà ÝÊÃ ó ïàöèåíòà ìîæíî óâèäåòü "áîëüøèå" êðèòåðèè ÀÄÏÆ:
- ýïñèëîí-âîëíà - "-" Ò ñ V1 ïî V4 Àáëàöèÿ áûëà íå î÷åíü óñïåøíîé, ïðè ïîäàâëåíèè àðèòìèè â îäíîì ìåñòå, àðèòìîãåííûé î÷àã ïîÿâëÿëñÿ â äðóãîì. Ïàöèåíò æèâ, ïðèíèìàåò êîðäàðîí, áûëî íåñêîëüêî ñðàáàòûâàíèé ÊÂÄ. |
#19
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ÝÊÃ ¹2. Ïàöèåíò ñ îñòðûì êîðîíàðíûì ñèíäðîìîì (ÎÊÑ).
Ìóæ÷èíà 42 ëåò âûçâàë "03" ñ æàëîáàìè íà íåòèïè÷íûé äëÿ ñòåíîêàðäèè áîëåâîé ñèíäðîì â ãðóäíîé êëåòêå (ñì. ÝÊÃ).
Ãîñïèòàëèçèðîâàí â ÃÊÁ ñ äèàãíîçîì ÎÊÑ. |
#20
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Îáìîðîêè îòðèöàåò, ñåìåéíûé àíàìíåç íå îòÿãîùåí.
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#21
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Ïðîøó ïðîùåíèÿ, òîãäà êàêóþ êàðòèíó îïèñûâàþò ïðè ÝõîÊÑ?
Òåïåðü Âû ñêàæåòå, ÷òî ýòî íå Áðóãàäà - Coved type... è ïàöèåíò íå ïðèíèìàë ïñèõîòðîïíûå ïðåïàðàòû? |
#22
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#23
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Äèôôåðåíöèàëüíûé äèàãíîç ýëåâàöèè ST
Íåìíîãî î äèôôåðåíöèàëüíîì äèàãíîçå ýëåâàöèè ñåãìåíòà ST
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#24
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#25
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Äèôôåðåíöèàëüíûé äèàãíîç ýëåâàöèè ST
Åùå íåìíîãî êàðòèíîê èç ñòàòüè [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]:
1. Òàáëèöà ¹1 - äèôô. äèàãíîç ïðè íåèøåìè÷åñêîé ýëåâàöèè ST 2. Èíôàðêò ìèîêàðäà 3. Ñèíäðîì ðàííåé ðåïîëÿðèçàöèè 4. Ãèïåðòðîôèÿ ìèîêàðäà ËÆ 5. Îñòðûé ïåðèêàðäèò 6. |
#26
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6. Áëîêàäà ëåâîé íîæêè ï.Ãèñà
7. ÄÊÌÏ 8. ñèíäðîì Áðóãàäà 9. Òàêîöóáî |
#27
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Ãîëîñîâàíèå ïî ÝÊÃ ¹2
Óâàæàåìûå êîëëåãè, ïðîñüáà ïðîãîëîñîâàòü, âûáèðàÿ íàèáîëåå ïîäõîäÿùèé îòâåò ïî ÝÊÃ ¹2 (æåëàòåëüíî ñ êîììåíòàðèÿìè):
1. Ãèïåðòðîôèÿ ìèîêàðäà ËÆ 2. Áëîêàäà ËÍÏÃ/íåñïåöèôè÷åñêèå íàðóøåíèÿ âíóòðèæåëóäî÷êîâîé ïðîâîäèìîñòè 3. Ñèíäðîì ðàííåé ðåïîëÿðèçàöèè 4. Íîðìàëüíûé âàðèàíò ýëåâàöèè ST 5. "Âîãíóòàÿ" (concave) ýëåâàöèÿ 6. STEMI ïîñëå ñïîíòàííîé ðåïåðôóçèè 7. Àíåâðèçìà/ÏÈÊÑ 8. Ïåðèêàðäèò/ìèîêàðäèò 9. WPW 10. Ïàòòåðí Áðóãàäà 11. Ñèíäðîì Òàêîöóáî 12. Ãèïåðêàëèåìèÿ 13. Ãèïåðêàëüöèåìèÿ 14. Ñîáñòâåííî, èíôàðêò ìèîêàðäà |
#28
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Ìîæåò áûòü èçìåíåíèÿ ñâÿçàíû ñ íåîáû÷íûì ïîëîæåíèåì ýë. îñè ñåðäöà. S1, S2, S3, ïîâîðò ñåðäöà âîêðóã ïðîäîëüíîé îñè ïî ÷àñîâîé ñòðåëêå + ÁÏÍÏÃ.
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#29
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#30
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ãîëîñóþ çà âàðèàíò 12 (åñëè óæ ïîçâîëèòå): ÀÂ-áëîêàäà 1 ñòåïåíè, âûñîêèå çàîñòðåííûå Ò, Áðóãàäîïîäîáíàÿ ýëåâàöèÿ ST â ïðàâîãðóäíûõ îòâåäåíèÿõ, òàêæå îòìå÷àåòñÿ óäëèíåíèå èíòåðâàëà QT (440ìñ ïðè RR 720ìñ)
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |