{"id":23311,"date":"2023-01-05T04:37:00","date_gmt":"2023-01-04T20:37:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=23311"},"modified":"2023-01-05T05:47:01","modified_gmt":"2023-01-04T21:47:01","slug":"bmj%e5%9c%a3%e8%af%9e%e4%b8%93%e5%88%8a%ef%bc%9a%e5%bf%83%e7%94%b5%e5%9b%be%e6%b5%8b%e8%af%95","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=23311","title":{"rendered":"[BMJ\u5723\u8bde\u4e13\u520a]\uff1a\u5fc3\u7535\u56fe\u6d4b\u8bd5"},"content":{"rendered":"\n

Endgames<\/strong> Christmas 2022: Brain Stew<\/p>\n\n\n\n

Electrocardiogaffe<\/h1>\n\n\n\n

Patricia McGettigan, Ian C Cooper, Jennifer H Martin,\u00a0et al<\/h3>\n\n\n\n

BMJ<\/em>\u00a02022;\u00a0379\u00a0doi:\u00a0https:\/\/doi.org\/10.1136\/bmj-2022-074083<\/a>\u00a0(Published 19 December 2022)Cite this as:\u00a0BMJ<\/em>\u00a02022;379:e074083<\/h3>\n\n\n\n
\n

Because a physician has possessed himself of an electrocardiograph, a polygraph, an x-ray machine, a blood pressure instrument, or some ingenious form of stethoscope, it does not at all follow that he has become competent to judge a patient\u2019s condition; not infrequently the very reverse is the case, for more often than not the limitations of these devices are far from being comprehended.Thomas Lewis, British Medical Journal<\/em> 19191<\/a><\/q><\/p>\n<\/blockquote>\n\n\n\n

In 1912, the then\u00a0British Medical Journal<\/em>\u00a0published Thomas Lewis\u2019s work entitled \u201cThe electro-\u200bcardiogram and its importance in the clinical examination of heart affections.\u201d2<\/a>\u00a0His recording apparatus was enormously cumbersome compared with today\u2019s sleek machines (fig 1<\/a>), but, remarkably, he could record amplitude in the range of 0.1 millivolts. Lewis\u2019s classic representation of the normal PQRST complex is still instantly recognisable over a century later (fig 2<\/a>).1<\/a>2<\/a><\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Current media representations of ECGs, however, often fail to reflect the electrical constancy of the heart. We found, in a short search of Google Images using the terms \u201chealthy heart,\u201d \u201cheart attack,\u201d and \u201ccardiac society,\u201d that few depicted a normal waveform. Roughly a quarter of the 45 images we considered<\/strong>showed pathological ECG complexes, but many more featured outright bizarre complexes, previously unrecognised in clinical practice\u2014electrocardiogaffes, as we call them. Even some well known healthcare organisations included strange ECG waveforms in their logos.4<\/a>5<\/a>6<\/a><\/p>\n\n\n\n

Many of these internet ECG images would have induced palpitation in Lewis or perhaps set off a premature atrial contraction in a practising cardiologist. We hope that clinicians have acquired the essential skill of interpreting ECGs but admit that it can be hard to tell normal from abnormal from fabricated. When in doubt, do what we did\u2014ask a cardiologist.<\/p>\n\n\n\n

Electrocardiogaffe quiz<\/h2>\n\n\n\n

Select the most plausible pathophysiological explanation for each ECG waveform below to find the electrocardiogaffe. We do not guarantee that the clues will help.<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n

ECG 1: \u201cHears the rub\u201d <\/h3>\n\n\n\n
    \n
  • A Acute myocardial infarction<\/li>\n\n\n\n
  • B Brugada syndrome<\/li>\n\n\n\n
  • C Lown-Ganong-Levine syndrome<\/li>\n\n\n\n
  • D Pericarditis<\/li>\n\n\n\n
  • E Ventricular pre-excitation<\/li>\n<\/ul>\n\n\n\n
    \"\"\/<\/figure>\n\n\n\n

    ECG 2: \u201cMmm . . .\u201d<\/h3>\n\n\n\n
      \n
    • A Atrial fibrillation<\/li>\n\n\n\n
    • B Bizarre ECG<\/li>\n\n\n\n
    • C P mitrale<\/li>\n\n\n\n
    • D Ventricular extrasystole<\/li>\n\n\n\n
    • E Ventricular fibrillation<\/li>\n<\/ul>\n\n\n\n
      \"\"\/<\/figure>\n\n\n\n

      ECG 3: \u201cArtificial additive\u201d<\/h3>\n\n\n\n
        \n
      • A Atrial fibrillation<\/li>\n\n\n\n
      • B Bizarre ECG<\/li>\n\n\n\n
      • C Left bundle branch block<\/li>\n\n\n\n
      • D Pericarditis<\/li>\n\n\n\n
      • E Ventricular fibrillation<\/li>\n<\/ul>\n\n\n\n
        \"\"\/<\/figure>\n\n\n\n

        ECG 4: \u201cI think we are in for a shock\u201d<\/h3>\n\n\n\n
          \n
        • A Atrial fibrillation<\/li>\n\n\n\n
        • B Complete heart block<\/li>\n\n\n\n
        • C Parkinson\u2019s disease<\/li>\n\n\n\n
        • D Ventricular fibrillation<\/li>\n\n\n\n
        • E Ventricular tachycardia<\/li>\n<\/ul>\n\n\n\n
          \"\"\/<\/figure>\n\n\n\n

          ECG 5: \u201cNot getting very far\u201d<\/h3>\n\n\n\n
            \n
          • A Atrial premature beat<\/li>\n\n\n\n
          • B First degree AV block<\/li>\n\n\n\n
          • C Hypothermia with J (Osborne) wave<\/li>\n\n\n\n
          • D Long QT syndrome<\/li>\n\n\n\n
          • E Normal ECG<\/li>\n<\/ul>\n\n\n\n
            \"\"\/<\/figure>\n\n\n\n

            ECG 6: \u201cShort circuit\u201d<\/h3>\n\n\n\n
              \n
            • A First degree AV block<\/li>\n\n\n\n
            • B Junctional rhythm<\/li>\n\n\n\n
            • C P pulmonale<\/li>\n\n\n\n
            • D Ventricular bigeminy<\/li>\n\n\n\n
            • E Ventricular pre-excitation<\/li>\n<\/ul>\n\n\n\n
              \"\"\/<\/figure>\n\n\n\n

              ECG 7: \u201cAt the junction\u201d<\/h3>\n\n\n\n
                \n
              • A First degree AV block<\/li>\n\n\n\n
              • B Junctional rhythm<\/li>\n\n\n\n
              • C Left anterior hemiblock<\/li>\n\n\n\n
              • D Normal ECG<\/li>\n\n\n\n
              • E Sinus arrhythmia<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

                Endgames Christmas 2022: Brain Stew Electrocardiog […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[13,18],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/23311"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=23311"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/23311\/revisions"}],"predecessor-version":[{"id":23312,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/23311\/revisions\/23312"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=23311"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=23311"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=23311"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}