Combined mitral valve lesion with a predominance of stenosis in a state of compensation is manifested by an indistinctly pronounced right type, "mitral" P in standard leads I and II. Decompensation of combined mitral malformation reveals a distinct right type, often flickering and fluttering of the atria. Insufficiency of the aortic valves results in a left-hand type of electrocardiogram, discordant mixing of the ST segment and negative T-waves. The latter is probably a sign of relative coronary insufficiency due to the discrepancy between blood flow and the metabolic needs of the hypertrophied heart muscle. In combined mitral-aortic malformations, changes in the electrocardiogram depend on the predominance of one or another defect. Mutual balancing of the changes is possible - then there is no deviation of the isoelectric axis of the heart. The addition of tricuspid valve insufficiency deepens the degree of the right type of electrocardiogram. The increase in cardiac decompensation in patients with rheumatic valve disease causes atrial fibrillation and flutter, persistent extrasystole, intraventricular conduction disorder. Dry (fibrinous) rheumatic pericarditis may not cause changes in the electrocardiogram, but, usually accompanied by myocardial damage, it often causes the appearance of a peculiar electrocardiographic pattern.
1. In the acute stage, there is a concordant increase in the ST intervals in standard and thoracic leads, especially in standard II. The ST segments pass directly into the positive T-teeth.
2. The subacute stage reduces the ST segments to almost an isoline and their concavity. The T-teeth decrease and gradually turn into negative ones.
3. In the chronic stage, the ST segments are on the isoline, the T-teeth are moderately negative, eventually turning into positive ones.
Chronic adhesive pericarditis - on an electrocardiogram is characterized by low voltage of the teeth, an increase and deformation of the P-teeth (atrial congestion), a decrease (concordant) in the ST segments and negative T-teeth. Atrial fibrillation and paroxysmal tachycardia often occur. The presence of atrioventricular block in combination with deformity of the P-teeth is characteristic of adhesive pericarditis of rheumatic etiology. Effusion pericarditis with a small amount of fluid gives the same electrocardiogram picture as dry pericarditis. When a large amount of fluid accumulates in the pericardial cavity, the voltage of the electrocardiogram teeth decreases sharply. The ST segments, concordantly elevated in all leads, turn into reduced or negative T-waves. The further dynamics of electrocardiographic data as exudate decreases is the same as in dry pericarditis, and is accompanied by an increase in the voltage of the electrocardiogram waves. Many players overlook the importance of entering a bonus code, missing out on significant extra value. To avoid this mistake, always use
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