♦♦خطيئة الصيدليات

تقوم الصيدليات هذه الأيام بالجرائم التالية:1.إعدام قيمة المضادات الحيويــــة بشكل متدرج نتيجة الكثـــرة الرهيبة لصرف مضادات البكتيريا والفيروسات والفطرية من ذات أنفسهم دون كشف الطبيب بجرعـات دون إكليكينية فأدي ذلك الي تكوين هاي ريزستانس بكتيرية وفيروسية وفطرية عالية قللت من كثير من الأجيال المكتشفة حديثا والسابق اكتشافها قديمــــــا حتي وصلت نسبة انعدام فاعلية الدواء الي مالا يقل عن 50%الأمر الذي سينشأ عنه في المستقبل القريب عدم فاعلية معظم المضادات الحيوية وانظر المدونة

السبت، 8 أبريل 2017

Acute inferior myocardial infarction

A 55 year old man with 4 hours of "crushing" chest pain.

Acute inferior myocardial infarction

ST elevation in the inferior leads II, III and aVF

reciprocal ST depression in the anterior leads

See also acute anterior MI.

Right Bundle Branch Block and sinus bradycardia are also present.

Normal adult 12-lead ECG

Normal ECG

Normal adult 12-lead ECG

The diagnosis of the normal electrocardiogram is made by excluding any recognised abnormality. It's description is therefore quite lengthy.
normal sinus rhythm
each P wave is followed by a QRS
P waves normal for the subject
P wave rate 60 - 100 bpm with <10% variation
rate <60 = sinus bradycardia
rate >100 = sinus tachycardia
variation >10% = sinus arrhythmia
normal QRS axis
normal P waves
height < 2.5 mm in lead II
width < 0.11 s in lead II
for abnormal P waves see right atrial hypertrophy, left atrial hypertrophy, atrial premature beat, hyperkalaemia
normal PR interval
0.12 to 0.20 s (3 - 5 small squares)
for short PR segment consider Wolff-Parkinson-White syndrome or Lown-Ganong-Levine syndrome (other causes - Duchenne muscular dystrophy, type II glycogen storage disease (Pompe's), HOCM)
for long PR interval see first degree heart block and 'trifasicular' block
normal QRS complex
< 0.12 s duration (3 small squares)
for abnormally wide QRS consider right or left bundle branch block, ventricular rhythm, hyperkalaemia, etc.
no pathological Q waves
no evidence of left or right ventricular hypertrophy
normal QT interval
Calculate the corrected QT interval (QTc) by dividing the QT interval by the square root of the preceeding R - R interval. Normal = 0.42 s.
Causes of long QT interval
myocardial infarction, myocarditis, diffuse myocardial disease
hypocalcaemia, hypothyrodism
subarachnoid haemorrhage, intracerebral haemorrhage
drugs (e.g. sotalol, amiodarone)
hereditary
Romano Ward syndrome (autosomal dominant)
Jervill + Lange Nielson syndrome (autosomal recessive) associated with sensorineural deafness
normal ST segment
no elevation or depression
causes of elevation include acute MI (e.g. anterior, inferior), left bundle branch block, normal variants (e.g. athletic heart, Edeiken pattern, high-take off), acute pericarditis
causes of depression include myocardial ischaemia, digoxin effect, ventricular hypertrophy, acute posterior MI, pulmonary embolus, left bundle branch block
normal T wave
causes of tall T waves include hyperkalaemia, hyperacute myocardial infarction and left bundle branch block
causes of small, flattened or inverted T waves are numerous and include ischaemia, age, race, hyperventilation, anxiety, drinking iced water, LVH, drugs (e.g. digoxin), pericarditis, PE, intraventricular conduction delay (e.g. RBBB)and electrolyte disturbance.
normal U wave

© Copyright ECG Library 1995 - 2014. Dean Jenkins and Stephen Gerred.
The ECGs and associated images on ecglibrary.com may be used for any non-commercial purpose as long as their source is acknowledged.
ECG Library is an educational resouce from the authors of ECGs by Example, 3rd Edition, Churchill Livingstone

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تنبيه وتحذير: اتقوا الله فيمن استأمنكم عليه

السبت، 8 أبريل 2017

Acute inferior myocardial infarction

A 55 year old man with 4 hours of "crushing" chest pain.

Acute inferior myocardial infarction

Normal adult 12-lead ECG

روابط موقع رسم القلب

Contents

ischaemic heart disease

hypertrophy patterns

atrioventricular (AV) block

bundle branch block

supraventricular rhythms

ventricular rhythms

pacemakers

Wolff Parkinson White syndrome

miscellaneous

other