--- In ekg_club@yahoogroups.com, haval surchi <havalandonlyhaval@...> wrote:
>
> Where is the attachment??
>
>
>  i wanted to comment on this topic.don't know how.
any way,if this one reaches u,then my answer will b<PAT WITH VARRIABLE
BLOCK/CONDUCTION.
> HAVAL LUTFALLA
>
> --- On Sat, 8/15/09, swalehin <drswalehin@...> wrote:
>
>
> From: swalehin <drswalehin@...>
> Subject: [ekg_club] Re: Rare ectopic rhythm
> To: ekg_club@yahoogroups.com
> Date: Saturday, August 15, 2009, 4:02 AM
>
>
>  
>
>
>
> --- In ekg_club@yahoogroup s.com, Klaus Skrudland <lapsklaus@ ..> wrote:
> >
> > Jesse -
> > You're probably looking at the right ekg, but as you can see the AV ratio
> > varies from cycle to cycle. The conduction is not 2:1. There also seems to
> > be AV dissociation, which is also not the case. There is some kind of 2AVB
> > here, you are correct about that. My problem is that I cannot figure out
> > which P waves are conducted and which are not, and what the specific kind of
> > block/conduction this is.
> >
> > Paul - I´ve attached them again to this email
> >
> >
> >
> >
> > On Mon, Jul 6, 2009 at 2:29 AM, jesse12848 <jesse12848@ ...> wrote:
> >
> > >
> > >
> > > --- In ekg_club@yahoogroup s.com <ekg_club%40yahoogr oups.com> ,
"jesse12848"
> > > <jesse12848@ > wrote:
> > > >
> > > > --- In ekg_club@yahoogroup s.com <ekg_club%40yahoogr oups.com> , Nikiah
> > > Nudell <medicnick@> wrote:
> > > > >
> > > > > Hi Jesse,
> > > > > I just wanted to clarify something you mentioned. Pwaves may be
present
> > > in
> > > > > PVCs or PACS. One has to be careful to determine whether the Pwave is
> > > > > 'associated' with the QRS complex.
> > > > >
> > > > > Some rythms can be tricky to differentiate in a 12 lead. If it is
> > > bigeminy
> > > > > with a bundle branch block, for example, it can be nearly impossible
to
> > > > > determine from a single 12lead which is the ectopy and which is the
> > > > > underlying rhythm.
> > > > >
> > > > > Cheers,
> > > > > Nick
> > > > >
> > > > > On Sun, Jul 5, 2009 at 11:12, jesse12848 <jesse12848@ > wrote:
> > > > >
> > > > > >
> > > > > >
> > > > > > --- In ekg_club@yahoogroup s.com <ekg_club%40yahoogr oups.com>
<ekg_club%
> > > 40yahoogroups. com>,
> > > > > > "thatsuthant" <thatsuthant@ > wrote:
> > > > > > >
> > > > > > > Hi every one,
> > > > > > > How do you differentiate atrial ectopic beats from ventricular
> > > ectopic
> > > > > > beats?. Any one can define me please?.
> > > > > > > Ventricular ectopic beats are clearly seen on ECG . But atrial
> > > ectopic
> > > > > > beats, how you all find those?. Please give some of your thoughts.
> > > > > > >
> > > > > > > Thanks
> > > > > > >
> > > > > > >
> > > > > > >
> > > > > > > --- In ekg_club@yahoogroup s.com <ekg_club%40yahoogr oups.com>
<ekg_club%
> > > 40yahoogroups. com>, Klaus
> > > > > > Skrudland <lapsklaus@> wrote:
> > > > > > > >
> > > > > > > > Hi all. Just want to present to you a case of what I believe is
a
> > > quite
> > > > > > > > uncommon ectopic rhythm.
> > > > > > > >
> > > > > > > > The patient is a 55 y/o male with a well known paroxysmal atrial
> > > > > > > > fibrillation. He uses flecainide and metoprolol and was admitted
> > > for
> > > > > > onset
> > > > > > > > of what he thought was atrial fibrillation.
> > > > > > > >
> > > > > > > > As you will see from the ecg, the ventricular rate is irregular.
> > > Right
> > > > > > > > precordial leads show ectopic, positive P waves. PP intervals
are
> > > > > > regular
> > > > > > > > with a rate of 230 bpm. When marching them out with a caliper
> > > (see the
> > > > > > dots
> > > > > > > > I made), they seem to march right through the QRS complexes and
> > > don´t
> > > > > > seem
> > > > > > > > to get conducted. However, there can´t be AV dissociation, as
> > > there is
> > > > > > no
> > > > > > > > evidence of an escape pacemaker present (and the ventricular
rate
> > > is
> > > > > > > > irregular).
> > > > > > > >
> > > > > > > > As a matter of fact, the P waves does seem to get conducted
after
> > > all.
> > > > > > My
> > > > > > > > colleague Terje (the other Norwegian here in the club) pointed
> > > out that
> > > > > > the
> > > > > > > > PR interval in fact gets progressively longer. And at this
point,
> > > I´m
> > > > > > > > struggling to understand the rest of the mechanism. Most likely,
> > > this
> > > > > > atrial
> > > > > > > > tachycardia with some kind of Wenkebach conduction.
> > > > > > > >
> > > > > > > > Comments? Thoughts? Ideas? Anyone wanna make a ladderdiagram to
> > > explain
> > > > > > the
> > > > > > > > mechanism?! ;-)
> > > > > > > >
> > > > > > > > klaus
> > > > > > > >
> > > > > > >
> > > > > > In the caes of a true atrial ectopic beat, the QRS will be preceded
> > > by a
> > > > > > definite, upright P wave. P wave morphology may fulctuate (wandering
> > > > > > pacemaker, etc.), but if the premature beat is truely atrial in
> > > origin then
> > > > > > a P wave will be present. Another way to distinguish PACs from PVCs
> > > is to
> > > > > > view them in leads I and III. Also remember that PACs have a QRS
> > > duration
> > > > > > time of < 0.12 sec, whereas PVCs almost always have duration times >
> > > 0.12
> > > > > > sec.
> > > > > > If your sure that it's a PVC your looking at, you can determine L or
> > > R
> > > > > > origin by viewing it in MCL1/v1. L vent PVCs will be positive in
> > > deflection
> > > > > > while R vent PVCs will be aberrant. Hope this helps.
> > > > > >
> > > > > >
> > > > > >
> > > > >
> > > > Nick, right on. Thats a great catch. It is important to determine wether
> > > the P wave is in fact associated with the QRS. Thanks for the correction.
> > > >
> > > I'm just a lowly paramedic :-), and I just looked at Klaus attached file
of
> > > the rhythm in question. V1 appears to display a 2nd degree type II AV
> > > blockade. Am I wrong in my interpretation or am I looking at the wrong
> > > rhythm? Sorry if I sound a little confused.
> > >
> > >
> > >
> >
> >
> >
> > --
> > Mvh,
> > Klaus Nilsen Skrudland
> >
> > http://www.lapsklau s.com
> > http://ecgblog. com
> > + 47 99 38 67 55
> >
> PAT WITH VARYING CONDUCTION.
> THIS EXPLAINS IRREGULARITY OF QRS COMPLEXES.
>