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ECG: Myocardial Infarction with CHB
ECG: Myocardial Infarction with CHB
ECG: Myocardial Infarction with CHB
ECG: Myocardial Infarction with CHB
ECG: Myocardial Infarction with CHB
ECG: Myocardial Infarction with CHB
ECG: Myocardial Infarction with CHB
ECG: Myocardial Infarction with CHB
ECG: Myocardial Infarction with CHB
ECG: Myocardial Infarction with CHB
ECG: Myocardial Infarction with CHB
ECG: Myocardial Infarction with CHB
ECG: Myocardial Infarction with CHB
ECG: Myocardial Infarction with CHB
ECG: Myocardial Infarction with CHB
ECG: Myocardial Infarction with CHB
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ECG: Myocardial Infarction with CHB

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  • 1. -Prof .Dr.Gowrishankar’s Unit -Dr.A.Ishwarya
  • 2.
    • 45 year old male patient was brought to ICCU with
    • C/O
      • CHEST PAIN * 2 HOURS
    • K/C/O T2DM/SHT
    • VITAL SIGNS
      • PR-54/Min
      • BP-90/74 mm hg
      • JVP RAISED
    • O/E
      • CVS: S1S2+
        • NO MURMUR
      • RS: B/L CREPS+
      • CNS:NFND
      • P/A:SOFT
  • 3.  
  • 4.  
  • 5.
    • Rate of P wave 80/min
    • Rate of QRS complex 60/min
    • Not in sinus rhythm
    • Duration of QRS <0.12 sec
    • P wave inverted in lead II, avf/ upright in aVr
    • Varying PR interval
    • PP interval constant (0.8 sec)
    • RR interval constant (1.12 sec)
    • ST elevation in lead II ,III ,aVf/ ST elevation in V3R-V5R,V7-V9
    • ST depression in lead I , aVL
    • R>S in Lead V2 & S > R in Lead aVL
    • ST depression in V2-V4 (mirrror changes of posterior MI)
  • 6.  
  • 7.  
  • 8.  
  • 9. Bradyarrhythmia-Type Incidence Sinus Bradycardia 25% Junctional Escape Rhythm 20% Idioventricular escape rhythm 15% I Degree AV Block 15% II Degree AV Block –Type 1 12% II Degree AV Block –Type 2 4% Complete Heart block 15% RBBB 7% LBBB 5% LAFB 8% LPFB 0.5%
  • 10.
    • Hyper vagotonia
    • Ischemia of AV node
  • 11.  
  • 12.  
  • 13. Site of block Intranodal Infranodal Site of infarction Inferoposterior Anteroseptal Compromised arterial supply RCA (90%), LCX (10%) Septal perforators of LAD Pathogenesis Ischemia, excess parasympathetic activity Ischemia, necrosis, hydropic cell swelling Predominant type of AV nodal block First-degree (PR > 200 msec) Mobitz type I second-degree Mobitz type II second-degree Third-degree Location Proximal conduction system (His bundle) Distal conduction system (bundle branches) QRS width <0.12/sec [*] >0.12/sec Rate 45-60/min but may be as low as 30/min Often <30/min
  • 14. Stability of escape rhythm Rate usually stable; asystole uncommon Rate often unstable with moderate to high risk of ventricular asystole Duration of high-grade AV block Usually transient (2-3 days) Usually transient but some form of AV conduction disturbance and/or intraventricular defect may persist Associated mortality rate Low unless associated with hypotension and/or congestive heart failure High because of extensive infarction associated with power failure or ventricular arrhythmias
  • 15.  
  • 16.  

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