中國(guó)區(qū)國(guó)際心電圖培訓(xùn)課程之典型病例-說(shuō)課稿課件

1、中國(guó)區(qū)國(guó)際心電圖培訓(xùn)課程之典型病例-說(shuō)課稿課件中國(guó)區(qū)國(guó)際心電圖培訓(xùn)課程之典型病例-說(shuō)課稿課件中國(guó)區(qū)國(guó)際心電圖培訓(xùn)課程之典型病例-說(shuō)課稿課件中國(guó)區(qū)國(guó)際心電圖培訓(xùn)課程之典型病例-說(shuō)課稿課件Case 1.a. Atrial septal defectb. Partial right bundle branch block c. Brugadas syndromed. False image of right bundle branch blockA young, asthenic man, with no apparent heart disease. The figure shows an ECG

2、 recording in V1, V2 and V3 leads located in 2nd (A), 3rd (B) and 4th (C) intercostal space. What is the correct diagnosis?Case 1.A young, asthenic man, Case 2A. Acute pericarditisB. Early repolarization in a subject with a horizontal heart with levorotation C. Acute phase of a myocardial infarction

3、D. Superoanterior hemiblock A 27year-old man, with no apparent heart disease. What is the correct diagnosis?Case 2A 27year-old man, with Case 3An 18-year-old lean man, asymptomatic, with no heartdisease. What is the correct diagnosis?A. Left ventricular enlargemenB. Normal ECG variant. Vertical hear

4、t with apparent levorotationC. Left ventricular enlargementD. Normal ECG. Heart with no rotation Case 3An 18-year-old lean man,Case 4A 28-year-old very lean man, with slight pectus excavatum, but with no apparent heart disease. What is the correct diagnosis?A. Right ventricular enlargementB. Heart w

5、ith the apex backwardC. Superoanterior hemiblock D. Vertical heartCase 4Case 5A 35-year-old man with no apparent heart disease. What is the correct diagnosis?A. Heart with no apparent rotationB. Vertical heartC. Horizontal heartD. Indeterminate electrical axisCase 5Case 6A 6-year-old child with no a

6、pparent heart disease. What is the correct diagnosis?A. Normal ECGB. Right ventricular enlargementC. Left ventricular enlargementD. PericarditisCase 6A 6-year-old child with Case 7These are leads V1 and V2 of a 60-year-old woman with a heart disease. Which is the correct diagnosis?A.Lateral myocardi

7、al infarctionB.Significant right enlargementC.Complete right bundle branch blockD.Type-II WolffParkinsonWhite SyndromeCase 7Case 8This is a 45-year-old patient suffering from a heart disease, with the diagnosis having been made 30 years ago. Which is the correct diagnosis?A.Significant left ventricu

8、lar and atrial enlargementB.Complete left bundle branch blockC.Complete superoanterior hemiblockD.Acute septal infarctionCase 8This is a 45-year-old paCase 9This is a 65-year-old patient. The history-taking presents antecedents of chronic obstructive pulmonary disease dating back more than 20 years

9、(recently with an acute crisis). Which is the correct diagnosis?A.Right ventricular and atrial enlargementB.Complete right bundle branch blockC.Acute coronary syndrome with a negative T wave from V1 to V3 D.Normal variant (vertically-orientated heart) with no associated diseaseCase 9Case 10This is a

10、 noncyanotic newborn with a systolic 5/6 murmur in the second left intercostal space. Which is the correct diagnosis?A.Ventricular septal defectB.Significant pulmonary stenosisC.Atrial septal defectD.Mitral regurgitationCase 10Case 11This is a 55-year-old patient with a known heart disease evolving

11、during more than 30 years. Which is the correct diagnosis? (ECG is shown at half voltage)A.Wolff-Parkinson-White SyndromeB.Complete left bundle branch blockC.Significant left ventricular enlargementD.Mild left ventricular enlargementCase 11Case 12This is a 30-year-old patient with a rsR morphology i

12、n V1. Which is the correct diagnosis?A.Right ventricular enlargement + partial right bundle branch blockB.Right bundle branch block of new onset due to a pulmonary embolismC.Isolated complete right bundle branch blockD.Brugadas syndromeCase 12Case 13This is a 45-year-old patient with signs of heart

13、failure and poor ventricular function. Which is the correct diagnosis?A.Partial left bundle branch blockB.Complete left bundle branch block in a patient with a dilated cardiomyopathy, probably of the ischemic type.C.Isolated complete left bundle branch blockD.Type-I WolffParkinsonWhite SyndromeCase

14、13Case 14This is a 34-year-old patient with frequent paroxysmal arrhythmia crises. Which is the correct diagnosis?A.Lateral myocardial infarctionB.Type-III WolffParkinsonWhite SyndromeC.Right ventricular enlargementD.Complete right bundle branch blockCase 14Case 15This is a 46-year-old patient with

15、frequent paroxysmal arrhythmia crises (see the recording at the bottom). Which is the correct diagnosis?A.Lateral myocardial infarction + ventricular tachycardiaB.Type IV WolffParkinson-White syndrome + paroxysmal atrial fibrillationC.Right ventricular enlargementD. Right bundle branch block + right

16、 ventricula enlargementCase 15Case 16This is a patient who suffered a myocardial infarction two days ago, and received early therapy with fibrinolytic agents. The ST-segment elevation in the acute phase was located in leads II, III and VF, with a more significant ST elevation in lead III than in II;

17、 ST-segment depression is found in lead I and ST-segment elevation is observed in the extreme right precordial leads and in V1-V2. Which is the artery involved in this infarction?A.Distal right coronary arteryB.Dominant right coronary artery proximal to the right ventricle branchC.Proximal left circ

18、umflex coronary arteryD.Distal left circumflex coronary arteryCase 16This is a patient who sCase 17This is a 55-year-old patient with an acute coronary syndrome involving the anteroseptal wall (ST-segment elevation in leads V1 through V5 and in VR and VL) and an evident ST-segment depression that is

19、 apparent in leads II, III, VF and V6. Give your comments, and your opinion, regarding the characteristics of the occluded artery and the localization of the stenotic lesion.A.Proximal occlusion of the left anterior descending coronary artery before the take-off of the first diagonal and first septa

20、l branchesB.Occlusion of the left anterior descending coronary artery proximal to the take-off of the first diagonal branch, but distal to the take-off of the first septal branchC.Occlusion of the left anterior descending coronary artery distal to the take-off of the first diagonal branch and the fi

21、rst septal branchD.Occlusion of the first diagonal branchCase 17Case 18This is a 62-year-old patient with an acute myocardial infarction that occurred one month ago. Which is the infarction location?A.Impossible to locateB.Isolated inferiorC.Isolated lateralD.InferolateralCase 18Case 19This is an as

22、ymptomatic 35-year-old patient, with no abnormal findings on physical examination. In your opinion, which is the diagnosis?A.Severe aortic stenosisB.Hypertrophic cardiomyopathyC.AthleteD.Ischemic heart diseaseCase 19Case 20This is a 65-year-old patient complaining of palpitations. No chest pain is r

23、eferred. Which is the correct diagnosis?A.Normal variantB.Chronic lateral infarctionC.Hypertrophic cardiomyopathyD.Heart displaced by a large left pleural effusionCase 20Case 21This is an ECG from 57-year-old male patient who has presented several rest angina crises during the last hours,lasting ove

24、r 30 minutes (acute coronary syndrome). This ECG recording is frequently seen in acute coronary syndromes presenting with involvement of one of thefollowing coronary arteries:A.Proximal right coronary arteryB.Left main or equivalent C.Two-vessel disease D.Proximal left anterior descending coronary a

25、rteryCase 21This is an ECG from 57-Case 22This is from a 34-year-old patient, athlete, asymptomatic, presenting during a check-up with tall QRS complexes in V5 - 6 with a positive T wave, rSr in V1 and first-degree atrioventricular block in the ECG. Which is the correct diagnosis?A.Normal variant in

26、 an athlete. The nocturnal and during exercise response of the first degree atrioventricular block should be assessed.B.The V1 morphology advises to rule out Brugadas pattern.C.Biventricular enlargement.D.Right bundle branch block, supported by the presence of a rsr morphology in V1.Case 22This is f

27、rom a 34-year-Case 23R wave in I and II leads, and RS waves in III lead, corresponds to an QRS of ?A.+90B.+30C.+150D.60Case 23R wave in I and II leWhere is the QRS ?Where is the QRS ?Where is the QRS ?Where is the QRS ?Case 24How is R wave in V1 in comparison to q wave of V6, in the ECG of a child ?A.EqualB.RV1 QV6C.RV1 Q6D.Depending on genderCase 24How is R wave in V1 in Case 25Which of the following ECG morphologies is one of the most important criteria for right ventricular enlargement?Prominent S wave in V6Prominent R wave in V6Gre