[EKG] Amal Mattu's Weekly 整理

1. 看到 Irregular rhythm (在下A.fib這個診斷之前)，一定要先看是否有 "clumps" (Regularly-irregular); D/dx:

(a) Premature beats (通常會在clumps之後造成pauses)

(b) Mobitz (2nd degree AV block)

2. PR-interval是區分AV-block的主角 (看lead V1)

(a) Fixed: 1st degree AV block, 2-2 AV block

(b) Prolonging: 2-1 AV block

(c) Variating: 3 AV block

3. 若對區分2-1及2-2 AV block有疑慮，就看"沒有傳下去的P"的"前一個"及"下一個"PR-interval長度: (相等: 2-2, (b) 下一個比前一個長: 2-1)

4. 生平第一次發生"seizure"要作EKG來rule-out dysrhythmia

5. AV-dissociation (atrial rhythm & ventricular rhythm各跳各的) 不一定是complete heart block；若atrial rhythm傳的下去就是AV-dissociation without complete heart block (會看到QRS的morphology改變)

6. RBBB有看到STE或V1~3以外的lead有STD皆異常 (正常在V1~3是會有STD及TWI)

7. 在infero-antero-lateral lead (II,III,aVF,V3~6)有看到isolated TWI表示有pulmonary hypertension; 若看到new TWI則要想到pulmonary embolism

8. 看到 (low voltage + tachycardia) 要先rule-out pericardial effusion