Наглядные пособия

ЛИТЕРАТУРА

I.Использованная при подготовке лекции:

Бойцов С.А., Захарова А.И., Захарова И.М., Кучмин А.Н. Электрокардиографические симптомы и синдромы /Под ред. В.П.Андрианова, Л.Л.Боброва.- Санкт-Петербург, 1996.

Болезни сердца и сосудов /Под ред. Е.И.Чазова, М.,1992.

Дощицин В.Л. Лечение аритмий сердца. – М.: Медицина, 1993.

Кушаковский М.С. Аритмии сердца (причины, механизмы, электрокардиографическая и электрофизиологическая диагностика, клиника, лечение). Руководство для врачей.— Санкт-Петербург: Гиппократ, 1992.

Лепахин В.К., Белоусов Ю.Б., Моисеев В.С.Клиническая фармакология с международной номенклатурой лекарств, М.,1988.

Терапевтический справочник Вашингтонского университета.— Boston: Little, Brown, and Company, 1992.

Интенсивная терапия / Под ред. А.И.Мартынова, А.М.Москвичева, В.В.Яснецова. – М.: Гэотар Медицина, 1998. – 639 с.

Руксин В.В. Основы неотложной кардиологии. – Санкт-Петербург: Политехника, 1995. – 303 с.

The Sicilian Gambit. A new Approach to the Classification of Antiarrhythmic Drugs Based on Their Actions on Arrhythmogenic Mechanisms. Task Fors of the Working Group on Arrhythmias of the European Society of Cardiology //Circulation. – 1991. – Vol.84. – P.1831-1851.

The Sicilian Gambit. A new Approach to the Classification of Antiarrhythmic Drugs Based on Their Actions on Arrhythmogenic Mechanisms. Task Fors of the Working Group on Arrhythmias of the European Society of Cardiology //European Heart Journal. – 1991. – Vol.12. – P.1112-1131.

Schwartz P.J., Zaza A.The Sicilian Gambit – Theory and Practice //European Heart Journal. – 1992 (supplement F). – Vol.13. – P.23-29.

II.Рекомендуемая слушателям для самостоятельной работы:

Бойцов С.А., Захарова А.И., Захарова И.М., Кучмин А.Н. Электрокардиографические симптомы и синдромы /Под ред. В.П.Андрианова, Л.Л.Боброва.- Санкт-Петербург, 1996.

The Sicilian Gambit. A new Approach to the Classification of Antiarrhythmic Drugs Based on Their Actions on Arrhythmogenic Mechanisms. Task Fors of the Working Group on Arrhythmias of the European Society of Cardiology //Circulation. – 1991. – Vol.84. – P.1831-1851.

The Sicilian Gambit. A new Approach to the Classification of Antiarrhythmic Drugs Based on Their Actions on Arrhythmogenic Mechanisms. Task Fors of the Working Group on Arrhythmias of the European Society of Cardiology //European Heart Journal. – 1991. – Vol.12. – P.1112-1131.

Schwartz P.J., Zaza A.The Sicilian Gambit – Theory and Practice //European Heart Journal. – 1992 (supplement F). – Vol.13. – P.23-29.

1. Таблицы:

n классификация ААП,

n сравнительная характеристика ААП,

n ААП для купирования пароксизмальных нарушений ритма,

n ААП для предупреждения нарушений ритма (при приеме внутрь),

n схема «сицилианского гамбита»;

n взаимодействие ААП.

2. Диапозитивы.

7. Vol. 4, No. 3 January 1999. Article No. 99010001. http://www.heartweb.org/heartweb/0199/p0001.htm

WIDE QRS COMPLEX TACHYCARDIA:
A NEWLY SIMPLIFIED DIAGNOSTIC CRITERIA
Hassan Khaled Nagi, Khaled Farouk, Ahmed Abd El-Aziz,
Sherif Hamed, Mohamed Hammouda, and Sherif Mokhtar
Critical Care Medicine, Cairo University, Egypt

ABSTRACT

Diagnosis of ventricular tachycardia (VT) has been always a diagnostic challenge. Physicians under training frequently misdiagnose wide complex tachycardia and are more tempted to think of aberrant SVT thus justifying the use of iv calcium blockers, or lanoxin with adverse hemodynamic consequences. All published criteria to diagnose wide complex tachycardia were based on complicated analysis of QRS morphology, duration and relative ratios of r/s in different leads, a rather non practical way in the critical care setting. We are hereby reporting a newly tested simplified scheme based on analysis of QRS morphology in 4 leads only rather than a complete twelve lead ECG analysis. Our data were obtained from 815 pts (61 male, 20 female, mean age 47.8+13.9 years) admitted with a diagnosis of wide complex tachycardia (QRS > 120 ms). Clinical diagnoses included ischemic HD in 28 pts, dilated CM in 13, congenital HD in 3, HTN in 7 and rheumatic HD in 6 pts. All had an electrophysiological study (EPS) which confirmed the tachycardia origin. ECG tracings during the tachycardia were analyzed for the polarity of QRS in leads I, II, V1 and V6. The presence of predominantly negative QRS in at least two out of those four leads (lead I or V6 to be included) was looked for.

Of the 81 pt. studied, 56 had EPS diagnosis of VT. Of the latter, 51 (89.2%) were correctly diagnosed by our newly suggested criteria. Absence of these criteria correctly diagnosed SVT with aberration in all the 25 pts with SVT. Sensitivity, specificity, positive predictive and negative predictive values were 89.2%, 100%, 100% and 80.6% respectively.

Predominantly negative QRS in at least two out of four leads (I, II, V1 and V6, with either Lead I or V6 included) diagnosed VT in 89.2% of cases, SVT in 100% of cases. Thus 94.5% of all cases were correctly diagnosed. Presented for the first time, they can be used as a simple approximate tool to differentiate wide complex tachycardia in critical care settings and may help avoid misdiagnosis with its therapeutic risks.

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