ECG Guru - Instructor Resources - COPD https://www.ecgguru.com/ecg/copd en Jason's Blog: ECG Challenge of the Week for July 8-15. Which lead do both of these ECGs share a “common-thread”? https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-july-8-15-which-lead-do-both-these-ecgs-share-%E2%80%9Ccommon-thread%E2%80%9D <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/jasons-blog-ecg-challenge-week-july-8-15-which-lead-do-both-these-ecgs-share-%E2%80%9Ccommon-thread%E2%80%9D"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201d.png" width="765" height="835" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>&nbsp;</p> <p class="MsoNormal"><span style="font-family: times new roman,times; font-size: medium;"><span style="line-height: 115%;">Two more ECGs classified under the general heading:&nbsp; </span><span style="line-height: 115%;"><em>“Tracing suggestive of &nbsp;&nbsp;____ ”</em></span></span><span style="font-family: times new roman,times; font-size: medium;">.&nbsp; I&nbsp; like ECGs that strongly favor a very specific clinical disorder. </p> <p> </span><span style="font-family: times new roman,times;"><span style="font-size: medium;">Recently I performed these ECGs on two different patients.&nbsp; They were both recorded a little more than an hour apart and exemplified a common electrocardiographic theme I noticed during that work shift.</span><span style="font-size: medium;"></p> <p></span></span><span style="font-size: medium; font-family: times new roman,times;"><span style="line-height: 115%;">The primary goal of this week’s blog is <em>not</em> to determine the name of each ECG’s rhythm but rather what each ECG is virtually diagnostic of.</span></span><span style="font-size: medium;"><span style="line-height: 115%;"></span></span><span style="font-family: times new roman,times; font-size: medium;"><span style="line-height: 115%;"></p> <p></span></span><span style="font-family: times new roman,times;"><span style="font-size: medium;"><span style="line-height: 115%;">This </span></span><span style="font-size: medium;"><span style="line-height: 115%;"><em>sign</em> is commonly referred to by one of two names:&nbsp; (1.)&nbsp; Either by the <em>lead</em> that it appears in or (2.) <em>eponymously</em></span></span><span style="font-size: medium;"><span style="line-height: 115%;"> named after the doctor who is credited with first describing it.</span></span></span><span style="font-family: times new roman,times; font-size: medium;"><span style="line-height: 115%;"> &nbsp; </span></span></p> <p><span style="font-family: times new roman,times;"><span style="font-size: medium;"><span style="line-height: 115%;">To date, the ECG machine's computer is not programmed to recognize this particular sign<strong>/</strong>pattern nor will it make the suggestion to consider this possibile clinical disorder in it's statements printed at the top of ECG</span></span><span style="font-size: medium;"><span style="line-height: 115%;">.&nbsp; Hopefully, in the future, manufacturers of ECG machines will add this algorithm to their computer's diagnostic statements.<br /></span></span></span><span style="font-family: times new roman,times; font-size: medium;"><br /> </span><span style="font-size: medium; font-family: times new roman,times;"><strong><span style="text-decoration: underline;">Patients’ clinical data:</span></strong></span><span style="font-family: times new roman,times; font-size: medium;"><br /> </span></p> <!--[if gte mso 9]><p><xml><br /> <o:OfficeDocumentSettings><br /> <o:RelyOnVML/><br /> <o:AllowPNG/><br /> </o:OfficeDocumentSettings><br /> </xml><![endif]--></p> <!--[if gte mso 9]><p><xml><br /> <w:WordDocument><br /> <w:View>Normal</w:View><br /> <w:Zoom>0</w:Zoom><br /> <w:TrackMoves/><br /> <w:TrackFormatting/><br /> 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line-height: 115%; font-family: 'Times New Roman','serif'; color: blue;">Fig. 1</span></span></strong><span style="font-family: times new roman,times;"><span style="text-decoration: underline;"><span style="font-size: medium;"><strong><span style="color: blue; text-decoration: underline;"></span></strong></span></span><span style="font-size: medium;">&nbsp;(Top tracing): 61-year-old black man, underweight, active smoker (long history of tobacco abuse), and persistent <em>cough</em>.&nbsp; The challenge for me was to obtain an artifact-free tracing in between coughing fits.&nbsp;</span></span><span style="font-family: times new roman,times;"><span style="font-size: medium;">When asked, this patient<em> </em>denied having this medical condition that his provider had diagnosed him with.</span></span></li> </ul> <ul> <li><strong><span style="text-decoration: underline;"><span style="font-size: 12pt; line-height: 115%; font-family: 'Times New Roman','serif'; color: blue;">Fig. 2</span></span></strong><span style="font-family: times new roman,times;"><span style="text-decoration: underline;"><span style="font-size: medium;"><strong><span style="color: blue; text-decoration: underline;"></span></strong></span></span><span style="font-size: medium;"> (Bottom tracing): 70-year-old white man, active smoker (long history of tobacco abuse).&nbsp; When asked, this patient <em>also</em> denied having this medical condition that his provider had diagnosed him with.</span></span></li> </ul> <p><span style="font-family: times new roman,times;"><span style="font-size: medium;">Personally, I think that a certain degree of denial goes hand-in-hand in this patient population when confronted with their self-destructive vices.<br /></span><span style="font-size: medium;"><br /> </span></span><span style="font-size: medium; font-family: times new roman,times;">So, both men have similar (albeit limited) histories and a similar clue on their ECGs.</span><span style="font-family: times new roman,times;"><span style="font-size: medium;">&nbsp; </span></span><span style="font-size: medium; font-family: times new roman,times;">In each of the two ECGs, there is a single lead where the waveforms look nearly identical.</span><span style="font-family: times new roman,times;"><span style="font-size: medium;"> </span></span><span style="font-family: times new roman,times;"><span style="font-size: medium;"><br /> </span></span></p> <ul> <li><span style="font-family: times new roman,times;"><span style="font-size: medium;"><strong><span style="text-decoration: underline;"><span style="color: #00b050;">Hint # 1:</span></span></strong></span><span style="font-size: medium;">&nbsp; The answer to the clinical disorder is a 4-letter acronym.</span><span style="font-size: medium;"></span></span></li> </ul> <ul> <li><span style="font-family: times new roman,times;"><span style="font-size: medium;"><strong><span style="text-decoration: underline;"><span style="color: #00b050;">Hint # 2:</span></span></strong></span><span style="font-size: medium;">&nbsp; The only thing that superficially mimics this pattern is simultaneously switching the arm cables with their respective leg cables on the same side (i.e., <a href="http://lifeinthefastlane.com/wp-content/uploads/2011/12/bilateral-arm-leg-reversal.jpg" target="_blank">RA reversed with RL <em>and</em></a></span><span style="font-size: medium;"><a href="http://lifeinthefastlane.com/wp-content/uploads/2011/12/bilateral-arm-leg-reversal.jpg" target="_blank"> LA reversed with LL</a>)</span></span></li> </ul> <p><span style="font-family: times new roman,times;"><span style="font-size: medium;"><strong><span style="text-decoration: underline;"><span style="color: red;"> </span></span></strong></span></span><span style="font-family: times new roman,times;"><span style="font-size: medium;"><strong><span style="text-decoration: underline;"><span style="color: red;">Questions:</span></span></strong></span><span style="font-size: medium;"><span style="line-height: 115%;"><br /></span></span></span></p> <ul> <li><span style="font-family: times new roman,times;"><span style="font-size: medium;"><span style="line-height: 115%;">(1.)&nbsp; Which one of the 12 individual leads am I referring to<em> and<strong> . . .</strong></em></span></span></span></li> <li><span style="font-family: times new roman,times;"><span style="font-size: medium;"><span style="line-height: 115%;">(2.)&nbsp; What clinical disorder is that lead a highly specific marker of?</span></span></span><span style="font-family: times new roman,times;"><span style="font-size: medium;"><span style="line-height: 115%;"><br /></span></span></span></li> </ul> </div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/138/feed" 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Which lead do both of these ECGs share a “common-thread”? 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for July 8-15. Which lead do both of these ECGs share a “common-thread”? 2/5</option><option value="60" selected="selected">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for July 8-15. Which lead do both of these ECGs share a “common-thread”? 3/5</option><option value="80">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for July 8-15. Which lead do both of these ECGs share a “common-thread”? 4/5</option><option value="100">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for July 8-15. 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