Dr. Smith, on his ECG Blog, has posted a must-see video presentation by famous ECG guru, Dr. K. Wang, discussing how helpful PVCs can be. Dr. Smith's blog is one of the best out there for ECG fans, and Dr. Wang is a wonderful teacher. The ECG Guru highly recommends both.
Jason is taking a break (everyone needs one now and then). April's ECG will appear through May, as well. It's a good one!
Ever since I first had a vague idea of what an ECG is, and looks like, I have noticed that graphics artists ALMOST NEVER get it right when using ECGs in advertising. Especially bothersome to me is when the graphic representation of an ECG is on the side of an ambulance, rescue vehicle, or hospital! Up until now, it has bothered me to no end, but today I found Drew Rinella's hillarious blog, "Stupid Heart Rhythms".
At this time of posting, I currently have no clinical data for this patient. This ECG is of interest because of its arrhythmic and nonarrhythmic elements.
I can think of at least two possible explanations for the mechanism of this rhythm and both would benefit from being illustrated by a laddergram.
One mechanism is rather exotic and has not been previously seen here on this website or discussed in the various FB forums.
Patient's clinical data: 66-year-old white man.
Amongst the computer's several statements was the interpretation of "Undetermined rhythm". To the computer's statement, the reviewing cardiologist added the freehand text of "Abnormally slow" but failed to provide a diagnosis.
What is accounting for this pattern?
This ventriculogram shows the typical apical ballooning of the left ventricle during Tako-tsubo myocardiopathy. This serious condition can be caused by extreme stress, such as in the death of a loved one, or prolonged high stress levels. The ECG will usually show ST elevations indicating an anterior wall M.I., but the angiogram will show no arterial occlusions. Tako-tsubo myopathy causes a sudden onset of congestive heart failure. It is transient, and those who survive it generally recover fully. For an excellent and complete discussion of Broken-Heart Syndrome
Patient's clinical data: 47-year-old black man. Another serial ECG (seen below) showed a supraventricular tachycardia (SVT) at a rate of 164/min that was diagnosed by an Electrophysiologist as atrioventricular nodal reentrant tachycardia (AVNRT). How does knowing the mechanism of AVNRT help you in determining the nature of the mechanism in this week's ECG.
The ECG Guru now has a You Tube site where you can find videos to enhance your classes. As with all ECG Guru content, there is no charge and no copyright. Ventriculograms are often obtained during a cardiac cath procedure. A curved, or pigtail, catheter is inserted through the arterial access line into the aorta and then the left ventricle. Contrast is introduced into the left ventricle and the pumping function of the ventricle can be observed. The structure and function of the aorta and mitral valve may also be observed during this procedure.
At this link, you will find a ventriculogram showing a normally-functioning left ventricle with an excellent ejection fraction. For your students, ventriculograms can illustrate muscle function visually, and are a great aid when teaching ECG. Watch the ECG Guru website and YouTube page for more ventriculograms and other cath lab videos.