#451
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Ðàçìåñòèòå ñêàíû ÝÊÃ íà êîêîì-íèáóäü ôîòîõîñòèíãå, íàïðèìåð, radikal.ru, ñþäà äàéòå ññûëêè.
P.S. Ê ñîîáùåíèþ èçîáðàæåíèÿ íå ïðèêðåïëÿéòå... |
#452
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[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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#453
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[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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#454
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âîò, ðàçîáðàëñÿ êàê ðàçìåùàòü Ïàöèåíò ñ ÄÏÏ (ÂÏÂ)
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#455
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[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
Òîò æå ïàöèåíò |
#456
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Ïî ïåðâîé ïëåíêå, ÈÌÕÎ, ïðîèñõîäèò ïðèìåðíî ñëåäóþùåå: íà÷èíàåòñÿ ÀÂÐÒ (îðòîäðîìíàÿ) ñ áëîêàäîé íîæêè (ïî âèäó êîìïëåêñîâ - ëåâîé, êàêîìó îòâåäåíèþ ñîîòâåòñòâóåò Y4?), íà âðåìÿ áëîêàäà ñíèìàåòñÿ - ïîÿâëÿåòñÿ óçêèé êîìïëåêñ, ÷åðåç íåáîëüøîå âðåìÿ ïîñëå âòîðîãî óçêîãî êîìïëåêñà ïîÿâëÿþòñÿ óçêîêîìïëåêñíàÿ òàõèêàðäèÿ - âåðîÿòíî, òà æå ÀÂÐÒ, áëîêàäà íîæêè ñíÿëàñü. Âåðíîñòü ýòîãî ïðåäïîëîæåíèÿ äîêàçûâàåò òîò ôàêò, ÷òî ÄÖ óçêîêîìïëåêñíîé òàõèêàðäèè êîðî÷å ÄÖ øèðîêîêîìïëåêñíîé - ò.å. â êîíòóð ðè-ýíòðè â ñëó÷àå øèðîêîêîìïëåêñíîé òàõèêàðäèè âêëþ÷åíà çàáëîêèðîâàííàÿ (÷àñòè÷íî?) ëåâàÿ íîæêà - çíà÷èò, ïó÷îê ëåâîñòîðîííèé. Ïî âòîðîé ïëåíêå ïóñòü îòâå÷àåò êòî-íèáóäü äðóãîé.
P.S. Æåëàòåëüíî ñòèðàòü ëè÷íûå äàííûå ïàöèåíòîâ. |
#457
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ñîãëàñåí ñ ëîãèêîé ðàññóæäåíèé, íå ñîãëàñåí ñ òåì, ÷òî åñëè ìîðôîëîãèÿ íîæêè òàêàÿ-òî òî è ïó÷îê ñ òîé æå ñòîðîíû, ïó÷îê ñ òîé æå - åñëè ÂÀ óâåëè÷èâàåòñÿ, ýòî áåç ýíäîýëåêòðîãðàììû íå óñòàíîâèøü.
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#458
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#459
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2 - àíòèäðîìíàÿ òàõèêàðäèÿ ó ïàöèåíòà ñ äåëüòà-âîëíîé (WPW-ñèíäðîì)?
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#460
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Õîòåë ïðåäëîæèòü åùå îäíó ÝÊà èç ðàéîíà (êðîìå ìîíîïîëÿðíîãî ÝÊà íè÷åãî íåò). Ìóæ÷èíó áåñïîêîèëè ýïèçîäû ñåðäöåáèåíèÿ è ïåðåáîè.
P.S.: ïðîøó íå îáðàùàòü çíà÷èòåëüíîãî âíèìàíèÿ íà íàäïèñè (ïðîñòî ìîëîäîé äîõòóð ïûòàëñÿ ïîíÿòü) [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Åñòü ïðåäïîëîæåíèå, ÷òî ýòî SA-áëîêàäà ïî ̸áèòö 2. ïî÷åìó-òî íå ìîãó çàãðóçèòü ôàéë ñ àäðåñà :-( |
#461
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Ïî ìíå òàê ýòî ïðåäñåðäíàÿ ýêñòðàñèñòîëèÿ (îäèíî÷íàÿ è ïàðíàÿ). Íà ÑÀ-áëîêàäó, êîòîðóþ äîêòîð èñêàë íå ïîõîæå.
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#462
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Ìóæ÷èíà. 54 ãîäà. Ýïèçîäû äèñêîìôîðòà â ãðóäíîé êëåòêå, ñåðäöåáèåíèé. Ïîñòóðàëüíàÿ ãèïîòåíçèÿ ñ ðåôëåêòîðíîé òàõèêàðäèåé. Ñëó÷àé âçÿò èç ñâåæàéøåé ëèòåðàòóðû.
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#463
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Àáñîëþòíî îñîçíàâàÿ íèçêèé óðîâåíü ñîáñòâåííîé êîìïåòåíòíîñòè õîòåë áû âñå-òàêè ðàçâèòü ïîñëåäíþþ ÝÊà è ñëåãêà ïîôëóäèòü: Áåçóñëîâíî áðîñàåòñÿ â ãëàçà èçìåíåíèÿ ST-T, â ñâÿçè ñ ÷åì âîçíèêëà ìûñëü î íàðóøåíèè ìèíåðàëüíîãî îáìåíà è â ïåðâóþ î÷åðåäü î ãèïîêàëèåìèè (è ñîîòâåòñòâåííî î ïàðîêñèçìàõ íàäæåëóäî÷êîâûõ òàõèêàðäèé) â òî æå âðåìÿ çàìåòíî óêîðî÷åíèå QRS äî 60 ìñåê, ÷òî íå õàðàêòåðíî äëÿ äàííîé âûøåîïèñàííîãî, íà ýòîì ôîíå QT íå âûãëÿäèò ñòîëü óæ ðàñøèðåííûì, à äàæå íàîáîðîò (~300 ìñåê - êàê-òî ìàëîâàòî) Èòàê ìûñëü ìîÿ ðàçäâàÿèöà - ëèáî ýòî ýíäîêðèíîëîãè÷åñêèé áîëüíîé (ÑÄ, íàäïî÷å÷íîêîâàÿ íåäîñòàòî÷íîñòü, ãèïîôèçàðíûå ïðîáëåìû è ò.ï.) ëèáî ó ïàöèåíòà ñêðûòûé WPW-ñèíäðîì. |
#464
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ÃÊÌÏ?
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#465
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In 1886, Fränkel found bilateral tumours of the adrenal gland at the autopsy of an 18-year-old girl who had died suddenly after collapse. Thiswasthefirst description of apatient with phaeochromocytoma. This case describes a 54-year-old patient who presented with recurrent episodes of chest discomfort, palpitations and fatigue. Postural hypotension with reflex tachycardia was the only abnormal clinical finding. Electrocardiography (ECG) showed deep widespread T wave inversion (panel A).
Cardiac enzymes, echocardiography and cardiac MRI were normal. At cardiac catheterisation, the coronary arteries were found to be angiographically normal. Causes of deep widespread Twave inversion on ECG are typically related to either myocardial ischaemia or cerebrovascular accidents, although other important causes need to be considereddurinary collection for catecholamines revealed markedly elevated levels of noradrenaline. CT and metaiodobenzylguanide scintigraphy revealed a left-sided extra-adrenal paraganglionoma. Blood pressure was stabilised with Phenoxybenzamine, and laparoscopic removal of the tumour was performed (panel B). Histology was that of classical phaeochromocytoma large polygonal, pleomorphic and spindly cells arranged in thick nests, separated from each other by a rich capillary vascular network. The cytoplasm was intensely granular and was stained pink and purple with H&E (panel C). Catecholamine-secreting tumours are recognised causes of elevated cardiac enzymes with normal coronary arteries, corrected QT prolongation and diffuse Twave changes on ECG. The precise mechanism remains unclear, although it may be due to a direct toxic effect of catecholamines on cardiac myocytes. Heart 2010;96:900 R Boyle, M S Spence Royal Victoria Hospital, Belfast, County Antrim, UK |