ABC of clinical electrocardiography by Francis Morris; William Brady; A John Camm

By Francis Morris; William Brady; A John Camm

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Indirect evidence of independent atrial activity Capture beat Occasionally an atrial impulse may cause ventricular depolarisation via the normal conduction system. The resulting QRS complex occurs earlier than expected and is narrow. indd 25 conduct normally, thus making a diagnosis of supraventricular tachycardia with aberrancy unlikely. Capture beats are uncommon, and though they confirm a diagnosis of ventricular tachycardia, their absence does not exclude the diagnosis. 8 Capture beat. 9 Fusion beat.

14 s). Consequently, this arrhythmia is commonly misdiagnosed as a supraventricular tachycardia. The QRS complexes have a right bundle branch block pattern, often with a small Q wave rather than primary R wave in lead V1 and a deep S wave in lead V6. When the tachycardia originates from the posterior fascicle the frontal plane axis of the QRS complex is deviated to the left; when it originates from the anterior fascicle, right axis deviation is seen. Right ventricular outflow tract tachycardia This tachycardia originates from the right ventricular outflow tract, and the impulse spreads inferiorly.

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.

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