ECG Guru - Instructor Resources

A gathering place for instructors of ECG and cardiac topics.

       

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The ECG GURU is devoted to providing resources for ECG teachers and their students. Follow the links above or the search terms to the left to find what you are looking for.  

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Instructors' Collection ECG of the WEEK, December 16, 2014 __ Right Ventricular Outflow Tract Tachycardia (RVOT)

Tue, 12/16/2014 - 01:00 -- Dawn

This ECG was taken from a patient who was complaining of palpitations and tachycardia, but who was hemodynamically stable, with no history of heart disease.  It is an example of RIGHT VENTRICULAR OUTFLOW TRACT TACHYCARDIA, a type of idiopathic ventricular tachycardia.  The ECG signs of RVOT are:  wide QRS complex, left bundle branch block pattern (QRS negative in V1 and positive in Leads I and V6), heart rate over 100 bpm, rightward or inferior axis (LBBB usually has a normal to leftward axis), AV dissociation.

RVOT accounts for about 10% of all ventricular tachycardias, and 70% of idiopathic VT.  It is most often found in structurally normal hearts, but it may occur in patients with arrhythmogenic right ventricular dysplasia.  For more on RVOT, read Life In the Fast Lane.

RVOT tachycardia sometimes converts with adenosine.  The patient in this example converted after being administered amiodarone.

ECG Basics: Paroxysmal Supraventricular Tachycardia

Fri, 11/21/2014 - 22:07 -- Dawn

This two-lead rhythm strip clearly shows the transition from normal sinus rhythm to a paroxysmal supraventricular rhythm.  In this case, the arrhythmia is AV nodal reentrant tachycardia, AVNRT.  The rate of the first rhythm, NSR, is around 75 per minute.  The fourth beat on the strip is a PAC which initiates the paroxysm of tachycardia lasting 12 beats.  The arrhythmia terminates spontaneously at that point.  The tachycardia rate is about 150/min.

The topic of supraventricular tachycardias can be a very complex one to teach.  For an excellent example of a concise lesson geared toward Primary Practice physicians, go to Dr. Grauer's VIDEO - Part III of his Arrhythmia series.

To cover the important points for the beginner-level student:

  *  It can be difficult to determine a rhythm is SVT if the rhythm is near 150 bpm and you DON'T see the beginning or end of the arrhythmia.  If the onset (or offset) is sudden, then this is not a sinus rhythm.  The sinus node speeds and slows more gradually - it doesn't change rates in one heartbeat.  This strip has an excellent view of BOTH the onset and the offset.

  *  The faster the rate, the more likely we are looking at a PSVT rather than sinus rhythm.  If a sinus tachycardia exists, we can almost ALWAYS see the reason for it in the patient's clinical situation.  We may see fever, dehydration, bleeding, fear, pain, exercise.  Therefore, a patient at rest with a rate of 150 would be suspect for PSVT.  A patient on a treadmill for 5 minutes would be considered to have a sinus rhythm.

  *  Any patient with a rate around 150 per minute should be evaluated for ATRIAL FLUTTER with 2:1 conduction.  Atrial flutter often conducts at that ratio, because a rate of 150 is fairly easy for the AV node to conduct, whereas the instrinsic rate of atrial flutter (250-350) is not.  A 12-lead ECG makes it easier to search for tell-tale flutter waves.

Ask The Expert

Fri, 11/21/2014 - 20:00 -- Dawn
Dr. Ken Grauer

QUESTION: 

Can you provide some guidelines on how to convey the large body of information associated with clinical evaluation and management of cardiac arrhythmias from a primary care perspective? 

Today’s Expert is the ECG Guru’s Contributing Expert, Dr. Ken Grauer. 

KEN GRAUER, MD is Professor Emeritus (Dept. Community Health/Family Medicine, College of Medicine, University of Florida in Gainesville).

Dr. Grauer has been a leading family physician educator for over 30 years. During that time he has published (as principal author) more than 10 books and numerous study aids on the topics of ECG interpretation, cardiac arrhythmias, and ACLS (including an ongoing Educational ECG Blog) . Dr. Grauer is the Contributing Expert for the ECG Guru. 

ANSWER: 

The topic of evaluating the patient with a cardiac arrhythmia – and then formulating an optimal approach to management is HUGE. It encompasses assessing both symptomatic and asymptomatic patients – determining if an arrhythmia is truly present, and if so, whether the arrhythmia is worrisome or benign – and then deciding on whether drugs, lifestyle changes, or referral for specialized EP (electrophysiologic) evaluation is in order. 

I have developed a 3-part (less than 90-minute) video series that addresses this tremendously important clinical topic from start to finish. Included in these videos are assessment of the patient, arrhythmia monitoring methods, when to refer, and targeted discussion of the most commonly encountered arrhythmias in primary care. These include ectopic beats (PACs; PJCs; PVCs) – ventricular arrhythmias (nonsustained vs sustained VT occurring in different clinical settings) – bradycardias (diagnosis of Sick Sinus Syndrome plus indications for pacing) – MAT – PSVT/AVNRT – Atrial Flutter – and Atrial Fibrillation. 

Links to these 3 Videos – plus LOTS of additional relevant information (including pdf excerpts available for free download from my ECG and ACLS ePubs on specifics of arrhythmia diagnosis) – is now all available for use on my new clinical arrhythmia webpage, www.fafpecg.com. I hope this material is helpful to you in your teaching! The beauty of these videos is that content is appropriate and understandable for primary care providers of virtually any level or degree of training – and that by assignment, learning can be entirely self-instructional OR under your direct guidance and instruction.  

P.S. I am still finishing a Power Point Show (without audio) that you can use if you choose to teach this subject yourself using my slides. This should be completed soon. The rest of this web page is finished and READY for use. Your comments and feedback is WELCOME!


If you have a question for one of our Experts, please email your question to:  Dawn.ECGGuru@gmail.com

ECG TEACHING VIDEOS - An Important Tool For Teachers and Students Alike

Thu, 09/11/2014 - 23:40 -- Dawn

If you are a teacher, watching a masterful teacher present your topic can help you develop your style, and increase your own knowledge of your subject.  We don't all have the opportunity to attend live classes by the real ECG Gurus of the world, but many of them are now making FREE video lectures available to all of us. Even if you are not an instructor, for many of us, hearing and seeing the presentation is a more effective way to learn than just reading.    

ECG videos are plentiful on the Web.  That being said, we want to be careful who we learn from.  Anyone can publish anything now.  Fortunately, there are some really good teachers out there making videos.  The ECG Guru website would like to recommend two in particular:

Dr. Ken Grauer, MD, is a consulting expert for this website.  Most of you are aware of his website and his excellent print and e-pub publications.  But, he has recently begun making ECG instructional videos, and they are excellent!  Each video is presented in a methodical, organized way, with clear illustrations.  There is something for everyone, from the beginner to the advanced ECG user, including instructors.  To see Dr. Grauer's bio, go to this LINK.  Follow this link to watch his ECG videos.

Dr. Amal Mattu, MD, FACEP, is also well-known to regular readers of the ECG Guru website.  He is an Emergency physician and faculty member at the University of Maryland.  He presents an ECG Video of the Week every week, and they are outstanding!  You will love his conversational style, and his markup illustrations as he progresses through each week's case.  His focus is very clinical and practical, and he manages to be very entertaining as well.  If you are an instructor, you will learn a lot about teaching style from Dr. Mattu.  For his bio, go to this LINK.  Follow this link to his ECG Videos. 

 

Broken Heart

Click to open: 
Heart Art, Broken Heart, Heart Leaf Illustration

Looking for an illustration for your presentation or packets?

Photograph by Alyssa Bean.  May be used free of charge and free of copyright in instructional setting.  Please contact the artist at Dawn.ECGGuru@gmail.com for any commercial use.

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