Source: Medical Data Encyclopedia
Atrial fibrillation related1. Atrial fibrillation rhythm: normal P wave disappears, R-R interval is different, and height is different! 2. On the electrocardiogram of patients with atrial fibrillation, if regular ventricular bigy rhythm appears on the basis of the original irregular ventricular rate, the possibility of “digital poisoning” should be considered! 3. The treatment plan for atrial fibrillation to control the ventricular rate: digoxin + betaloc (carvedilol)Explanation: digoxin controls the resting ventricular rate, Betaloc controls exercise ventricular rate. 4. Indication for CRT placement: “123435”Explanation: “12” means the QRS width exceeds 120 ms, “34” means cardiac function grade 3~4, “35” refers to an ejection fraction < 35%, plus a sinus rhythm. 5. About atrial fibrillation: three “inconsistent” signs, 3P classification, and three principles of treatmentSigns: absolutely irregular heart rhythm on auscultation, inconsistent heart sounds, inconsistent heart rhythm and pulse (short pulse)Classification:Paroxysmal atrial fibrillation rate, recovery sinus rate, anticoagulation. Cardiomyopathy and valvular heart disease1. Preload reduction for stenosis, afterload reduction for regurgitation 2. Mitral valve insufficiency murmur: the posterior valve passes forward and the anterior valve passes backward3. During cardiac auscultation, instruct the patient to do valsalva action, which can weaken almost all heart murmurs, but But it can lead to hypertrophic cardiomyopathy and mitral valve prolapse murmur enhancement. 4. Dilated cardiomyopathy: one is weak, two are weak, three are weak and four are weak. Explanation: large (heart enlargement), thin (thin wall), small (valve is relatively small, often with valve regurgitation), weak (weakened wall motion)5 , The left ventricle is a pressure device, not afraid of pressure and volume; the right ventricle is a volume organ, not afraid of volume and pressure, such as ventricular septal defect, the first cause of left ventricular enlargement (not the right ventricle). Others1. The use of protamine is like brined tofu (antagonizing the bleeding caused by heparin). 2. Simple treatment principles for acute pulmonary edema: “UNLOAD ME”Explanation: “U” means the head of the bed is too high; “N” nitrates (sublingual or “L” furosemide; “O” oxygen; “A” albuteramine (if needed to relieve bronchospasm); “D” dopamine or dobutamine; “M” “morphine; “E” electrical cardioversion of tachyarrhythmias (Af or Vf). 3. I always remember the etiology of secondary hypertension summarized by the professor. Both renal aldehyde pheochromoma, cortical arteries, and pregnancy-induced hypertension. Explanation: two kidneys—renal parenchymal hypertension, renovascular hypertension; primary aldehyde—primary hyperaldosteronism; pheochromoma—pheochromocytoma;corticoid—hypercortisolism;arterial—coarctation of the aorta;< span>Pregnancy-induced hypertension—pregnancy-induced hypertension. 4. Drugs for the treatment of hypertension: The first group: A (ACEI, ARB), B (B receptor blocker) The second group: C (Ca antagonists) ), D (diuretic) combination principle: combination between groups, no combination within the group (except for the elderly C+D). 5. Principles of the treatment of shock The first part: expansion, correction of acid and blood vessels; the second part: cardiac diuresis and anti-infection; horizontal part: hormones6. The effect of sudden drug withdrawal on the heart: like a small donkey pulling a heavy cart on the reins, once the reins are released, it will run happily. 7. Patients in a coma should consider “midbrain and lung low-glycemic liver”. Explanation:Middle: Poisoning, Alcoholic Phosphate Brain: Cerebrovascular Disease Lung: Pulmonary Encephalopathy Low: Hypotension Low: Hypoglycemia Sugar: DKA Liver: Hepatic Encephalopathy 8, Digitalis indications: Moderate heart failure and atrial fibrillation. Explanation: It is suitable for moderate-to-severe systolic heart failure, preferably for atrial fibrillation with fast ventricular rate. Digitalis contraindications: pre-excited atrial fibrillation block, within one day of acute myocardial infarction. Explanation: Pre-excitation syndrome, second degree or higher AVB, diastolic heart failure such as hypertrophic cardiomyopathy, within 24 hours of acute myocardial infarction. 9, Patients with sudden dyspnea that are not easy to explain have right bundle branch block with sinus tachycardia, suggesting acute pulmonary embolism. 10. In addition to cardiac tamponade, chronic obstructive pulmonary disease, right ventricular infarction and pulmonary embolism should also be thought of in the presence of an odd pulse. ECG related1. ECG leads: Dr. yellow and green, left hand and left foot, right hand holding red flag~2. Low QRS voltage with jugular venous filling and narrowing of pulse pressure suggests cardiac tamponade! 3. The director of the ward round said: “After 2 months of myocardial infarction, ST segment elevation persisted, suggesting the existence of aneurysm!”4. Patients with unexplained syncope The ECG should look for 3 waves: Brugada wave, obvious J wave, Epsilon wave, and some suggest that syncope is cardiogenic! 5. There are two possibilities for abnormal QRS complex: ventricular arrhythmia and intraventricular differential conduction. 6. Inferior wall myocardial infarction to see right ventricle: Inferior wall myocardial infarction must be checked for right ventricle. 7. Tombstone-like changes are inevitable: ST segment elevation reaches the apex of the R wave, and the mortality rate is 100%8. There is no dynamic change in the ECG in patients with chest pain, and the aorta must be considered mezzanine. Aortic dissection can present with any symptoms. 9. If the identification of wide QRS complex is unclear, it is treated as ventricular tachycardia. 10, Acute inferior myocardial infarction can sometimes belead changes to make the earliest diagnosis. The easily overlooked aVL lead is particularly helpful for diagnosis. Because the probe electrode is far away from the heart and the voltage is lower in the inferior leads, when myocardial infarction occurs, the magnitude of ST segment elevation is far less obvious than that in anterior myocardial infarction. Especially in ultra-early myocardial infarction, it is often manifested as “straightened ST segment”, and ST segment elevation is not obvious. At this time, there is often obvious ST segment depression in lead aVL. Failure to realize this can result in a missed MI with catastrophic consequences. 11. ST segment elevation is thrombolytic (red thrombus), and ST segment depression is antithrombotic (white thrombus). 12. Where there is a reelection, there must be a return. 13. Left posterior fascicular block is a right axis deviation, S deepening in lead I, and Qr waveforms in II, III, and F. 14. A normal PR interval does not necessarily mean normal atrioventricular conduction. 15, For RBBB pattern, the identification of VT and SVT with differential transmission is mainly waveform analysis. For LBBB patterns, the identification of VT and SVT with afferent transmission is primarily a temporal analysis.
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