ECG. PROBLEMS. John R. Hampton. Emeritus Professor of Cardiology. University of Nottingham. Nottingham. UK. DM MA DPhil FRCP FFPM FESC. This third edition includes real clinical case histories and their accompanying ECG readouts. The reader is asked to report and interpret each ECG and draw. ECG Problems by John Hampton, , available at Book Depository with free delivery worldwide.
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Third edition Fourth edition as The ECG Made Easy or The ECG in Practice is fine as far as it experience, ECG Problems goes a stage nearer. ECG Problems, 4e John R. Hampton DM MA DPhil FRCP FFPM FESC. ECG Problems, 2e John R. Hampton DM MA DPhil FRCP FFPM FESC.
The two subways, which are one of the first in the city, are used by thousands of commuters day round. There was initially a proposal to connect the two termini by means of an elevated section with double-line broad-gauge electrified track with two elevated platforms at Puratchi Thalaivar Dr. After being desilted in , the covered stretch of the canal near the terminus was cleaned in September Garbage is dumped into the canal via the openings near the Chennai Central premises.
Ramachandran Central Railway Station, completely destroying a bookshop. He was later safely persuaded back down the tower by the City Police and Southern Railway officials.
Two security booths were planned, one each at the main terminus and the suburban terminus. This involved dividing the terminus into six sectors and deploying 24 police personnel for security. In addition, explosive detection and disposal squad have been deployed. The sub-system will be integrated by networking and monitored at the centralised control rooms.
Existing CCTV network of suburban platforms has also been integrated to this system. For additional infrastructure, the goods yard at Salt Cotaurs will be closed to provide more pit line and stabling line facilities for the new terminal.
In February , as part of a national initiative to eliminate ballast tracks at major stations, washable aprons—ballastless tracks or tracks on a concrete bed—were installed along the entire length of tracks of platforms 3, 4 and 5 at the terminus. Washable aprons that are already present for a few metres in some of the platforms at the terminus will be extended, viz. More passengers amenities will be provided on a 1. Additional space for operational purposes, including the station master's room, passenger information centre, movement control room, Railway Protection Force control room containing closed circuit television CCTV cameras, Government Railway Police station, and Travelling Ticket Examiner chart room, covering a total of 2, The developer will maintain the station premises for 15 years, while the lease period of the additional land and aerial space to be developed will be 45 years.
The diagnosis of sinus arrhythmia is easily confirmed in most cases by observing the relation of the change to respiration slowing in expiration, accelerating in inspiration. Although these sinus pauses are seen in many individuals they are infrequent, almost invariably occurring in isolated cardiac cycles and with no more than two or three in a 24 hour period.
In both neonates and older children the longest pauses recorded were no more than 1. As sinus arrhythmia makes it difficult to measure the resting sinus cycle length in many children, the precise mechanism responsible for these pauses is uncertain in most cases.
Some may conform to patterns consistent with either sino-atrial block or sinus arrest, but without direct measurement of sinus node potentials a conclusive diagnosis is probably not possible.
Whatever the precise mechanism it is clear that such pauses are common at all ages. Although sinus node disease does occur in young children and can result in syncope, in the vast majority of children sinus pauses are benign.
These episodes of junctional rhythm usually follow a gradual slowing of the sinus rate during sleep, but may also occur during waking hours. In most individuals the episodes are short, lasting no more than a few seconds to about one minute, but occasionally more prolonged episodes lasting several hours have been reported.
A common pattern is for many short self limiting episodes to occur over several hours during sleep. The PR interval on resting 12 lead ECGs in children varies mainly in relation to heart rate and is therefore usually shorter in younger children. In teenagers with slower heart rates the upper limit of normal would be around ms.
Episodes of first degree heart block were more common during sleep and varied in duration from a few seconds to several hours. Occasional individuals may have first degree heart block as their normal resting heart rhythm. Some, but not all, of these individuals will have episodes of first degree atrioventricular block. Episodes may vary in number from single isolated events to many hundreds in a 24 hour period. In some individuals the atrioventricular block will persist as block for a few seconds after the initial Wenckebach sequence.
There are very occasional reports of progression of Mobitz type 1 atrioventricular block to complete atrioventricular block but such progression must be very unusual given the relatively frequent occurrence of Mobitz type 1 block in healthy asymptomatic children. Extrasystoles Isolated ventricular premature beats may be identified on a routine resting ECG in 0. Typically the extrasystoles are isolated, of uniform morphology, and are associated with periods of slower heart rates.
Multifocal extrasystoles are seen and in a small number of individuals couplets of ectopic activity occasionally occur. The frequency of extrasystoles is usually no more than 1—5 per hour, but occasional individuals will be seen with much more frequent ectopic activity or long periods of ventricular bigeminy.
Extrasystoles which conform to this pattern and suppress on exercise are almost certainly benign. This view is supported by very limited longer term follow up data, 15 but recently a cautionary note has been sounded by the observation that children with benign ventricular ectopy do have greater corrected QT interval dispersion than randomly selected controls.
Isolated supraventricular premature beats are fairly common at all ages. The usual pattern is for isolated ectopics to occur at a frequency of less than one per hour but occasional individuals often in the newborn period will be encountered with more frequent ectopic activity of up to 10 per hour.
Couplets are occasionally seen but sustained supraventricular tachycardia, even of short duration, was not identified in these studies of normal children.
Later studies have determined the maximum QRS duration from measurement of all leads and this fact may be responsible for the considerable differences in ranges between earlier and later studies.