Looks to me like a sinus rythm with an intermittant LBBB? Seems evidenced by the r and r1 you can see, and of course the widen ed QRS :) Mike MacKinnon ... ...
mike
mmackinnon@...
Jul 2, 2003 2:53 am
I'd really love to see the twelve lead or get the story behind this one, but to me it appears as if the patient was being paced slowly (unsure of the rate...
Looks like the baseline is a 1st degree block...interspersed with a run of 3rd degree block? Very interesting... Dave Dave Ferrand, MD PGY-1, Emergency...
Hmmm... looks to me like LBBB with 1 degree block (bifasicular) is the underlying rhythm (its the most stable of the two) changing to 3rd degree with a...
Strikes me that the underlying rhythm is sinus with a first degree heart block and some sort of interventricular conduction defect. This is the cause for the...
EMTA1497@...
Jul 2, 2003 9:23 am
You guys are doing great. Neil, for my own knowledge, how do you differentiate between LBBB and IVCD? The underlying rhythm is sinus with first degree AV...
Nick: Keep in mind that most of the time, 1ºAVB is pharmacologically induced, and is less a true "block" than a delay. You often hear cardiologists refer to ...
To amend my statement, ventricular escape beats would be at a slower rate (20-40) and the 5 complexes are faster then the underline but I still believe they...
JB: Escape rhythms by definition also come "late". This is how you can distinguish between a PVC and a ventricular escape beat, for example. PVCs are...
Michael: Sorry, no 12 lead for this patient. I collected this rhythm strip several years ago. Technically, this is a $B!H(Bsternal$B!I(B lead with the...
Tom, Yeah, I$B!G(Bve noticed that some MCL$B!G(Bs won$B!G(Bt pick up pacer spikes as readily as others (I was guesstimating that it might have something...
... Tom; You really can't differentiate the IVCD from a BBB without a 12 lead. Therefore all wide complex ECG's on a rhythm strip are IVCD until proven...
EMTA1497@...
Jul 2, 2003 2:06 pm
... Measure the P-P interval within the rR' area in the middle of the rhythm strip. You will see the the P-P interval is the same as the "native P-P" interval....
EMTA1497@...
Jul 2, 2003 2:09 pm
Neil: You're absolutely right about the AV dissociation, and the P waves marching through the strip. When I asked you to take it a step further, I was asking ...
John: Why multifocal? Tom ... From: John Gentzel [mailto:john_gentzel@...] Sent: Wednesday, July 02, 2003 9:42 AM To: ekg_club@yahoogroups.com Subject:...
And what would make it an escape rhythm as opposed to a short run of VT? Tom ... From: John Gentzel [mailto:john_gentzel@...] Sent: Wednesday, July 02,...
... It would be difficult to state catagorically but I would bet on ventricular beats as the source of the five beats in the middle of the rhythm strip. Neil...
EMTA1497@...
Jul 2, 2003 3:31 pm
Tom I would call it an arrhythmia because it is a more rapid rate then the sinus portions, too fast for an escape... Ok, so we have a sinus rhythm with PR...
Michael: This patient was on the cardiac step-down unit. While it is possible that the patient had a recent history of anteroseptal MI, he would not have been ...
Nick: You are exactly right that the 5 complexes in the middle of the strip represent an arrhythmia rather than an escape rhythm. If the arrhythmia was...
V1 or MCL-1 complexes should be mostly a negative deflection. These are upward strokes in which I am leaning to ventricular escape beats, as for the underline...
JB: This patient has a left bundle branch block. When left bundle branch block is present, you will only see an R wave in lead V1 (MCL-1) about 20% of the...
In a message dated 7/2/03 5:55:40 PM, TomB@... ... This is a left sided ventricular rhythm. The rR' is the hall mark with the lead...
EMTA1497@...
Jul 2, 2003 11:52 pm
One of the reasons that MCL leads won't pick up pacer spikes also is that if they are built in MCL leads as supposed to limb leads that you're "drafting a limb...
Jcbartus@...
Jul 3, 2003 1:16 pm
Tom this is Diagnostic (90% plus specificity): Bundle Branch block in MCL-1 can be diagnosed whenever the QRS complex is greater than .12 seconds. Start at the...
Jcbartus@...
Jul 3, 2003 1:25 pm
Chris: The Zymed system I used back in 1997 didn't pick up pacer spikes unless you entered setup options and set "pacer spikes" to the "on" position. Beyond...
Chris: I am familiar with right and left bundle branch block. Sometimes, however, the computer interpretation identifies a supraventricular rhythm with wide ...
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