Indigestion? - STA HealthCare Communications
Transcription
Indigestion? - STA HealthCare Communications
ECG clinic “Indigestion?” By Keith J.C. Finnie, MB, ChB; and L.J. Melendez, MD Vignette Question The electrocardiogram (ECG) shown in Figure 1 was taken in a 44-year-old patient complaining of retrosternal and epigastric discomfort (“like indigestion”). What is your electrocardiographic interpretation? Figure 1 Dr. Finnie is professor of medicine, University of Western Ontario, and site chief of cardiology, London Health Sciences Centre, Victoria Campus, London, Ontario. Dr. Melendez is professor of medicine, University of Western Ontario, and cardiologist, London Health Sciences Centre, Victoria Campus, London, Ontario. The Canadian Journal of Diagnosis / January 2003 47 ECG Clinic Answer The conspicuous abnormality shown by this ECG is the inversion of the T-wave in leads V1 through V4. It is also appreciable in leads III and AVF. Close inspection of the ST-segment shows elevation in leads V2 through V4. This association of ST-segment elevation with terminal inversion of the T-wave is highly specific of disease of the proximal left anterior descending coronary artery and is indicative of severe ischemia, injury or non-transmural necrosis of the interventricular septum. Because this territory includes the inferoapical region of the left ventricle, ischemic changes in this territory may be reflected in some of the “inferior wall leads,” namely II, III and AVF. T-wave inversion not accompanied by STsegment elevation is sometimes seen in precordial leads V1 to V3 in normal individuals, especially in black patients. It is not associated with ST-segment elevation. On the other hand, isolated ST-segment elevation with a configuration of a recumbent italic “S” may be found in precordial leads V1 to V3 of normal individuals, especially if there is increased amplitude of the QRS complexes in the same leads. However, it is not accompanied by terminal inversion of the T-wave. In all cases, electrocardiographic changes should be viewed in light of the patient’s history and other findings. Reference to previous electrocardiograms may be helpful. Dx www.stacommunications.com www.stacommunications.com Décembre 2002 LA REVUE DE FORMATION MÉDICALE CONTINUE Volume 17, numéro 12 Volume 18, No. 10 November/December 2002 December 2002 December 2002 Volume 14, number 12 38 How do I Know it’s Pneumonia? 64 HPV Testing & Cervical Cancer Screening: Are they Linked? In this issue: Focus on CME at Dr. Malvinder S. Parmar 53 l’Université de Volume 19, Number 12 Montréal 31 L’exercice et le diabétique de type 2 Les deux font la paire! Dr. William Chapman “I’m so Tired” When is it Really Chronic Fatigue Syndrome? 1 Denis Phaneuf, MD, MSc, FRCPC Coma Conundrum: The Comatose Raver 65 Regard sur la rosacée Dr Daniel Barolet Louise Laramée, MD, FRCPC Case of the Month 46 Prostate Cancer: Is There Standard Treatment? Pierre I. Karakiewicz, MD, FRCSC; Paul Perotte, MD, FRCSC; Fred Saad, MD, FRCSC 55 The Ins & Outs of Diuretic Therapy 33 36 Four Things You’ve Always Wanted to Know 76 Is Radical Mastectomy Necessary? Hope for Prostate Cancer Patients What is the Right for my Patient? 83 Something for the Pain: 89 How to Identify and Post-MI Complications Taking the Ouch Out A Case Study in Osteoarthritis Medical Briefs Insulin Regimen 74 Dr. Martin Cohen Dalhousie University CME Credit Quiz 31 Dermatological Diagnosis comment les diagnostiquer et les traiter? Les canneberges et la prévention des infections urinaires. Mythe ou réalité? Médi-test En collaboration avec l’Université Laval Relieving Chronic Non-Cancer Related Pain RV Infarctions L’amygdalite et ses complications : Dr Ted L. Tewfik 71 Update 122 Rheumatology: Post-Traumatic Stress Disorder: Is One Day’s Rest Enough? Update André Gougoux, MD, FRCPC 62 38 133 University of Calgary InforMed.doc Les vulvovaginites récidivantes : Quand un petit problème devient grand Les difficultés érectiles : un problème de plus en plus soulevé! An Introduction to PubMed New New Contest Contest! page 29 New! Emergency Cases Women and Coronary Disease A practical approach based on guidelines Dr Paul Poirier page 1 Win a Palm Pilot see see page page 47 47 Le cas du mois page 1 Voyage au soleil à gagner! Voir page 48 STATIN THERAPY FOLLOWS ANGIOPLASTY: THE LIPS TRIAL In Association With The Hamilton Health Science Corporation NON-SENSE OR NONSENSE ECG of the Month In Association With The University of Ottawa Heart Institute New! HEEDING THE SIGNS CardioCase of the Month