ECG Guru - Instructor Resources - Aberrant conduction https://www.ecgguru.com/ecg/aberrant-conduction en Atrial Fibrillation With Aberrant Conduction in Adolescent Patient https://www.ecgguru.com/ecg/atrial-fibrillation-aberrant-conduction-adolescent-patient <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/atrial-fibrillation-aberrant-conduction-adolescent-patient"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/081014%20Peds%20A%20Fib%20w%20Aberrant%20Cond%20Ryan%20Cihowiak%20%20at%20BRFR%20edited%20on%20EKG%20Club%20%26%20Guru.jpg" width="1800" height="1333" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p><strong>The Patient:</strong>&nbsp; This ECG was taken from a 14-year-old girl with a complaint of palpitations.&nbsp; Her medical history is not known.</p><p><strong>The ECG:</strong>&nbsp; The rate is about 160 bpm, with an irregularly-irregular rhythm.&nbsp; There are no P waves.&nbsp; This is atrial fibrillation.&nbsp; There are several different morphologies noted in the QRS complexes.&nbsp; First, a narrow QRS with normal axis, as demonstrated in beats #5 and #7.&nbsp; There are distinctly wide QRS complexes with a right bundle branch block pattern.&nbsp; See beats #2, #3, and #19.&nbsp; This represents aberrant conduction.&nbsp; Atrial fib often displays aberrant conduction, especially when a beat follows closely after a long R-R cycle followed by a short R-R cycle. The refractory period is set by the preceding cycle.&nbsp; So a lont R-R causes a longer refractory period.&nbsp; The short R-R that follows finds itself in a relative refractory period - not refractory enough to prevent conduction altogether, but in this case, the right bundle branch has not yet recovered, so the impulse continues down the left bundle, bypassing the right bundle branch.&nbsp; The right ventricle depolarizes late, causing a widening of the QRS.</p><p>There is a sliight variation seen in the aberrant beats, notably in #1 and #2.&nbsp; This may represent varying amounts of aberrancy, where the pathways change slightly from beat to beat.&nbsp; Atrial fibrillation is rare in children and adolescents, but can be caused by many factors, including stress, caffeine, endocrine disorders, obesity, and heart infections.&nbsp;&nbsp;</p><p>This ECG was published by me on Facebook nearly a decade ago, and received some excellent comments from Dave Richley and Dr. Ken Grauer (two of our favorite Gurus).&nbsp; I will reproduce them here to spare them re-writing their comments.</p><p><span style="font-family: 'Segoe UI Historic', 'Segoe UI', Helvetica, Arial, sans-serif; color: #050505; font-size: 12px; background-color: #f0f2f5;"><span class="xt0psk2" style="display: inline; font-family: inherit;"><a class="x1i10hfl xjbqb8w x6umtig x1b1mbwd xaqea5y xav7gou x9f619 x1ypdohk xt0psk2 xe8uvvx xdj266r x11i5rnm xat24cr x1mh8g0r xexx8yu x4uap5 x18d9i69 xkhd6sd x16tdsg8 x1hl2dhg xggy1nq x1a2a7pz x1heor9g xt0b8zv" style="color: inherit; cursor: pointer; outline: none; list-style: none; text-align: inherit; -webkit-tap-highlight-color: transparent; box-sizing: border-box; touch-action: manipulation; background-color: transparent; display: inline; font-family: inherit;" tabindex="0" href="https://www.facebook.com/groups/121568654592814/user/100000089832154/?__cft__[0]=AZX6WqHUWKpwcNRRyS7-WUF_c1U8ueD50xrV-Pe31DtymyHjJLGduuVDvOm9Wxt_nqs7A5CAQBIn4dpF0oMS5yGaYxysTAI41rbxFtbtG5OrwEgNnDQY-pffqh9mw9OWYrMglcC7YmgfQzzMuU_2t08V&amp;__tn__=R]-R"><span class="x3nfvp2" style="display: inline-flex; font-family: inherit;"><span class="x193iq5w xeuugli x13faqbe x1vvkbs x1xmvt09 x1lliihq x1s928wv xhkezso x1gmr53x x1cpjm7i x1fgarty x1943h6x x4zkp8e x676frb x1nxh6w3 x1sibtaa x1s688f xzsf02u" style="word-break: break-word; max-width: 100%; display: block; font-size: 0.8125rem; font-weight: 600; line-height: 1.2308; overflow-wrap: break-word; font-family: inherit; min-width: 0px; color: var(--primary-text);" dir="auto">David Richley</span></span></a></span></span></p><div class="x1rg5ohu" style="display: inline-block; font-family: inherit;"><div class="x6s0dn4 x1lcm9me x1yr5g0i xrt01vj x10y3i5r x3nfvp2 x1qx5ct2 x150jy0e x1e558r4 x1av1boa" style="border-radius: 4px; padding-right: 4px; background-color: var(--hosted-view-selected-state); padding-left: 4px; height: 20px; display: inline-flex; align-items: center; font-family: inherit;"><span class="x193iq5w xeuugli x13faqbe x1vvkbs x1xmvt09 x1lliihq x1s928wv xhkezso x1gmr53x x1cpjm7i x1fgarty x1943h6x x4zkp8e x3x7a5m x1nxh6w3 x1sibtaa xo1l8bm x1fey0fg" style="word-break: break-word; max-width: 100%; color: var(--blue-link); display: block; font-size: 0.8125rem; line-height: 1.2308; overflow-wrap: break-word; font-family: inherit; min-width: 0px;" dir="auto"><span class="x1lliihq x6ikm8r x10wlt62 x1n2onr6 xlyipyv xuxw1ft x1j85h84" style="overflow: hidden; padding-bottom: 1px; display: block; position: relative; text-overflow: ellipsis; white-space: nowrap; font-family: inherit;">Admin</span></span></div></div><p>&nbsp;</p><div class="x1lliihq xjkvuk6 x1iorvi4" style="padding-top: 4px; padding-bottom: 4px; font-family: 'Segoe UI Historic', 'Segoe UI', Helvetica, Arial, sans-serif; color: #050505; font-size: 12px; background-color: #f0f2f5;"><div class="xdj266r x11i5rnm xat24cr x1mh8g0r x1vvkbs" style="overflow-wrap: break-word; font-family: inherit;"><div style="font-family: inherit;" dir="auto">This is atrial fibrillation and I think that the beats labelled 1, 2, 3, 6 and 19 all show aberrant conduction (to various degrees). These beats may well be examples of the Ashman phenomenon in which the aberrancy follows a long RR-short RR sequence, but we would need to see a longer strip to be sure. Beat 1 appears to be conducted with a RBBB/LAFB pattern, whereas the other broad QRS complexes appear to show just a RBBB pattern (although LPFB in addition is a possibility). There is continuous variation in R-wave height through the lead II rhythm strip. This may be related to varying degrees of aberrancy, but perhaps it’s more likely to be at least partly due to respiratory chest wall movement because the variation appears to follow a regular ‘waxing and waning’ pattern.</div></div></div><p><span style="font-family: 'Segoe UI Historic', 'Segoe UI', Helvetica, Arial, sans-serif; color: #050505; font-size: 12px; background-color: #f0f2f5;"><span class="xt0psk2" style="display: inline; font-family: inherit;"><a class="x1i10hfl xjbqb8w x6umtig x1b1mbwd xaqea5y xav7gou x9f619 x1ypdohk xt0psk2 xe8uvvx xdj266r x11i5rnm xat24cr x1mh8g0r xexx8yu x4uap5 x18d9i69 xkhd6sd x16tdsg8 x1hl2dhg xggy1nq x1a2a7pz x1heor9g xt0b8zv" style="color: inherit; cursor: pointer; outline: none; list-style: none; text-align: inherit; -webkit-tap-highlight-color: transparent; box-sizing: border-box; touch-action: manipulation; background-color: transparent; display: inline; font-family: inherit;" tabindex="0" href="https://www.facebook.com/groups/121568654592814/user/100001436718709/?__cft__[0]=AZX6WqHUWKpwcNRRyS7-WUF_c1U8ueD50xrV-Pe31DtymyHjJLGduuVDvOm9Wxt_nqs7A5CAQBIn4dpF0oMS5yGaYxysTAI41rbxFtbtG5OrwEgNnDQY-pffqh9mw9OWYrMglcC7YmgfQzzMuU_2t08V&amp;__tn__=R]-R"><span class="x3nfvp2" style="display: inline-flex; font-family: inherit;"><span class="x193iq5w xeuugli x13faqbe x1vvkbs x1xmvt09 x1lliihq x1s928wv xhkezso x1gmr53x x1cpjm7i x1fgarty x1943h6x x4zkp8e x676frb x1nxh6w3 x1sibtaa x1s688f xzsf02u" style="word-break: break-word; max-width: 100%; display: block; font-size: 0.8125rem; font-weight: 600; line-height: 1.2308; overflow-wrap: break-word; font-family: inherit; min-width: 0px; color: var(--primary-text);" dir="auto">Ken Grauer</span></span></a></span></span></p><div class="x1lliihq xjkvuk6 x1iorvi4" style="padding-top: 4px; padding-bottom: 4px; font-family: 'Segoe UI Historic', 'Segoe UI', Helvetica, Arial, sans-serif; color: #050505; font-size: 12px; background-color: #f0f2f5;"><div class="xdj266r x11i5rnm xat24cr x1mh8g0r x1vvkbs" style="overflow-wrap: break-word; font-family: inherit;"><div style="font-family: inherit;" dir="auto">Agree - rapid AFib with probably all aberrant conduction. The very first beat seems to have LAHB in addition to RBBB aberration - beats #2,3 don't have the LAHB ...</div></div><div class="x11i5rnm xat24cr x1mh8g0r x1vvkbs xtlvy1s" style="margin-top: 0.5em; overflow-wrap: break-word; font-family: inherit;"><div style="font-family: inherit;" dir="auto">I don't think this an optimal illustration of Ashman phenomenon (Dave could have guessed I'd say that ....). Why doesn't the 2nd complex in V1 show more aberration than the 4th complex in V1? Now I know that the coupling interval of this 2nd beat in V1 is indeed slightly longer than the coupling interval of the 4th beat in V1 - but the preceding R-R before this 2nd beat is much longer than the preceding R-R of the 4th beat, so if true "Ashman" - I would have expected a greater degree of aberration for this 2nd beat. Otherwise - all we have is a relative long-short for the 6th complex in the long lead II with no information on preceding R-R intervals before the first 3 aberrant beats. Bottom Line - To invoke Ashman here I think is stretching it .... but I realize others may see the above in different light. That said - at least we can all agree this is rapid AFib with expected aberrant conduction</div></div></div><p><strong>Follow Up:&nbsp;</strong> The patient was diagnosed in the ER with "Atrial Flutter" and successfully cardioverted.&nbsp; We do not know the cause of the dysrhythmia or the outcome of the case.&nbsp; Our thanks to <strong>Ryan Cihowiak RN, Paramedic</strong>, for donating this interesting case.</p></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/171/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Atrial Fibrillation With Aberrant Conduction in Adolescent Patient 1/5</option><option value="40">Give Atrial Fibrillation With Aberrant Conduction in Adolescent Patient 2/5</option><option value="60">Give Atrial Fibrillation With Aberrant Conduction in Adolescent Patient 3/5</option><option value="80">Give Atrial Fibrillation With Aberrant Conduction in Adolescent Patient 4/5</option><option value="100">Give Atrial Fibrillation With Aberrant Conduction in Adolescent Patient 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="empty">No votes yet</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-1iNtyqTYwkrvihStJDTmDN06KYucnwEI1oie2AENetw" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/atrial-fibrillation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial fibrillation</a></div><div class="field-item odd"><a href="/ecg/aberrant-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Aberrant conduction</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fatrial-fibrillation-aberrant-conduction-adolescent-patient&amp;title=Atrial%20Fibrillation%20With%20Aberrant%20Conduction%20in%20Adolescent%20Patient"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Tue, 23 May 2023 21:59:22 +0000 Dawn 839 at https://www.ecgguru.com https://www.ecgguru.com/ecg/atrial-fibrillation-aberrant-conduction-adolescent-patient#comments Rate-related Left Bundle Branch Block https://www.ecgguru.com/ecg/rate-related-left-bundle-branch-block <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/rate-related-left-bundle-branch-block"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/LB117%20Rate%20dep%20LBBB%20w%20PAC%20edit%20on%20Guru.jpg" width="2980" height="2429" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal"><strong><span style="font-size: 12.0pt; line-height: 107%; color: #00b050;">The patient:</span></strong><span style="font-size: 12.0pt; line-height: 107%; color: #00b050;"><span style="mso-spacerun: yes;">&nbsp; </span></span><span style="font-size: 12.0pt; line-height: 107%;">This ECG is from an 87-year-old man who was transported to the Emergency Department by paramedics. His chief complaint, as reported by caregivers, was lethargy, fever, and a declining mental status.<span style="mso-spacerun: yes;">&nbsp; </span>He appeared tired and slightly confused, and was normotensive.</span></p><p class="MsoNormal"><strong><span style="font-size: 12.0pt; line-height: 107%; color: #00b050;">The ECG:</span></strong><span style="font-size: 12.0pt; line-height: 107%; color: #00b050;"><span style="mso-spacerun: yes;">&nbsp; </span></span><span style="font-size: 12.0pt; line-height: 107%;">There are a rhythm strip with two leads, II and III, and also a standard 12-lead ECG. The <strong>RHYTHM STRIP</strong> shows a tachycardiac rhythm that slows very slightly toward the end.<span style="mso-spacerun: yes;">&nbsp; </span>The rate is around 107 bpm, with an R to R interval of approximately 543 ms in the earlier, regular portion.<span style="mso-spacerun: yes;">&nbsp; </span>There are regular P waves present, all followed by QRS complexes.<span style="mso-spacerun: yes;">&nbsp; </span>Most of the QRS complexes are normal width, but the 2<sup>nd</sup>, 5<sup>th</sup>, and 8<sup>th</sup> are slightly wide at 130 ms, or .13 seconds.</span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">These wider QRS complexes represent aberrant conduction with LBBB occurring intermittently.<span style="mso-spacerun: yes;">&nbsp; </span>Aberrant conduction often occurs due to a faster heart rate, but the only clue here is the intermittent conduction disturbance seems to disappear when the rate slows very slightly.<span style="mso-spacerun: yes;">&nbsp; </span>It is hard to determine mechanism of aberrant conduction when we have only a ten-second rhythm strip.</span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">The <strong>12-LEAD ECG<span style="mso-spacerun: yes;">&nbsp; </span></strong>has essentially the same rate and rhythm, except all the beats in the first ¾ of the ECG are conducted aberrantly, in a LEFT BUNDLE BRANCH BLOCK pattern.<span style="mso-spacerun: yes;">&nbsp; </span>This indicates that the LBB is refractory at this time.<span style="mso-spacerun: yes;">&nbsp; </span>Beat No. 15 is premature (PAC).<span style="mso-spacerun: yes;">&nbsp; </span>The pause after the PAC allows the left bundle branch to repolarize, conducting one single beat normally.</span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%; color: #00b050;"><strong>Conclusion</strong>: </span><span style="font-size: 12.0pt; line-height: 107%;">The patient was determined to be septic, secondary to a urinary tract infection.<span style="mso-spacerun: yes;">&nbsp; </span>We do not know his outcome.</span></p></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/171/feed" method="post" id="fivestar-custom-widget--2" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--4" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Rate-related Left Bundle Branch Block 1/5</option><option value="40" selected="selected">Give Rate-related Left Bundle Branch Block 2/5</option><option value="60">Give Rate-related Left Bundle Branch Block 3/5</option><option value="80">Give Rate-related Left Bundle Branch Block 4/5</option><option value="100">Give Rate-related Left Bundle Branch Block 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >1.7</span></span> <span class="total-votes">(<span >121</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--2" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form--vvCrXXdeENf7FkPPvhWSWwkYiEex5e35GLwcvyzOV8" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/left-bundle-branch-block-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left bundle branch block</a></div><div class="field-item odd"><a href="/ecg/rate-related-lbbb" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Rate-related LBBB</a></div><div class="field-item even"><a href="/ecg/intermittent-bundle-branch-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Intermittent bundle branch block</a></div><div class="field-item odd"><a href="/ecg/premature-atrial-contraction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Premature atrial contraction</a></div><div class="field-item even"><a href="/ecg/pac" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">PAC</a></div><div class="field-item odd"><a href="/ecg/aberrant-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Aberrant conduction</a></div><div class="field-item even"><a href="/ecg/lbbb" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">LBBB</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_2"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Frate-related-left-bundle-branch-block&amp;title=Rate-related%20Left%20Bundle%20Branch%20Block"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Fri, 14 Jan 2022 22:58:54 +0000 Dawn 811 at https://www.ecgguru.com https://www.ecgguru.com/ecg/rate-related-left-bundle-branch-block#comments Wide-complex Tachycardia: Ventricular Tachycardia https://www.ecgguru.com/ecg/wide-complex-tachycardia-ventricular-tachycardia <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/wide-complex-tachycardia-ventricular-tachycardia"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/WCT118%20VT_0.jpg" width="1800" height="931" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal">This ECG is from a man who was experiencing palpitations and light-headedness with near-syncope.&nbsp;<span style="font-size: 13.008px; line-height: 1.538em;">On first look, you will see a wide-complex tachycardia (WTC) with a rate around 240 per minute.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">It is difficult to assess for the presence of P waves because of the rate and the baseline artifact.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">&nbsp;</p><p class="MsoNormal">The differential diagnosis of WCT includes ventricular tachycardia and supraventricular tachycardia with aberrant conduction, or interventricular conduction delay (IVCD). We should ALWAYS consider VENTRICULAR TACHYCARDIA first.&nbsp; If the patient is an older adult with structural heart disease, WCT almost always proves to be VT.<span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal"><strong>ABERRANT SVT?</strong>&nbsp; &nbsp;In the setting of SVT with wide QRS, the most common aberrancy is right or left bundle branch block.&nbsp; This ECG could be said to have a “RBBB” type pattern in V1, rSR’ and in Lead I and V6 with a wide S wave.&nbsp; However, the other precordial leads do not have a RBBB pattern.<span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal"><strong>VENTRICULAR TACHYCARDIA?</strong> There are some features of this ECG that favor the diagnosis of <a href="http://ecgguru.com/ecg/ventricular-tachycardia-2">VENTRICULAR TACHYCARDIA</a> (VT).&nbsp; They include, but are not limited to:</p><p class="MsoNormal">* Regular, wide QRS complexes, about .14 seconds in this ECG, but varies because of difficulty in measuring the beginning and end of the QRS in each lead.&nbsp; The artifact obscures the exact points of beginning and ending. The QRS complexes, especially from V2 leftward, are very “ugly”, and don’t resemble patterns we would expect with bundle branch block.</p><p class="MsoNormal">* Horizontal plane axis extremely abnormal:&nbsp; Leads II, III, and aVF are negative and aVR and aVL are positive.&nbsp; The biphasic Lead I indicates a nearly vertical axis at around – 90 degrees.</p><p class="MsoNormal">* There is “almost” precordial concordance, but V1 is biphasic.<span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal">Unfortunately, we do not see <a href="http://lifeinthefastlane.com/ecg-library/basics/vt_vs_svt/">capture beats</a> or fusion beats, which would secure the diagnosis of VT. Disassociated P waves would also be a sure sign of VT, but the artifact in this ECG makes it impossible to say whether there are P waves.<span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal"><strong>IDIOPATHIC POSTERIOR FASCICULAR TACHYCARDIA?</strong>&nbsp; This tracing also has features of <a href="http://lifeinthefastlane.com/ecg-library/fascicular-vt/">Posterior Fascicular Tachycardia</a>, a type of <strong>ventricular tachycardia</strong> sometimes called Belhassen-type Tachycardia.&nbsp; These include:</p><p class="MsoNormal">* Borderline QRS width.&nbsp; Fascicular tachycardia usually has a QRS duration of .10 - .14 seconds. (100-140 ms), narrower than other types of VT.</p><p class="MsoNormal">* Short RS interval in the precordial leads.&nbsp; The time from onset of the r wave to the nadir of the S wave appears to be between .04 sec. and .06 sec. &nbsp;&nbsp;The RS interval is usually .10 sec. (100 ms) or more in other types of VT.</p><p class="MsoNormal">* A RBBB pattern, with additional left anterior fascicular block (LAFB or LAHB) pattern.&nbsp; While not typical for RBBB in all the precordial leads, V1, V6 and Lead I suggest a RBBB pattern.</p><p class="MsoNormal">* Left axis deviation, indicating that, if this is fascicular tachycardia, it is arising from the posterior fascicle.</p><p class="MsoNormal">Fascicular tachycardia is an idiopathic tachycardia usually occurring in young, healthy patients, most often male.&nbsp; There is a lack of structural heart disease, and the tachycardia usually occurs at rest. The mechanism is re-entry of an ectopic beat from the left ventricle. It often responds to the use of Verapamil, rather than the usual drugs used for SVT and VT.<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal"><strong>BOTTOM LINE &nbsp;&nbsp;</strong><span style="font-size: 13.008px; line-height: 1.538em;">When faced with a patient with wide-complex tachycardia, the more information you have, the better. That includes patient history, family history, medications, signs and symptoms.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">A 12-lead ECG may prove to be invaluable, unless the patient is so severely unstable that there is no time.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">It can be very difficult to diagnose a WCT from these tools, and electrophysiology studies may prove beneficial.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal"><strong><span style="color: #c00000;">ALWAYS TREAT WCT AS VENTRICULAR TACHYCARDIA UNTIL IT IS PROVEN TO BE SOMETHING ELSE.</span></strong><span style="font-size: 8pt; line-height: 107%;">&nbsp;</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">Of course, we would welcome a discussion on this topic, sign in to comment below. (Sign in is necessary for our efforts to repel SPAMMERS.</span></p></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/171/feed" method="post" id="fivestar-custom-widget--3" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--6" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Wide-complex Tachycardia: Ventricular Tachycardia 1/5</option><option value="40">Give Wide-complex Tachycardia: Ventricular Tachycardia 2/5</option><option value="60">Give Wide-complex Tachycardia: Ventricular Tachycardia 3/5</option><option value="80" selected="selected">Give Wide-complex Tachycardia: Ventricular Tachycardia 4/5</option><option value="100">Give Wide-complex Tachycardia: Ventricular Tachycardia 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4</span></span> <span class="total-votes">(<span >5</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--3" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-gxgNXL5N4LBN48CDCqo3lGauhE3x4BZ22bIjWJ30C08" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/wide-complex-tachycardia-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wide-complex tachycardia</a></div><div class="field-item odd"><a href="/ecg/ventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ventricular tachycardia</a></div><div class="field-item even"><a href="/ecg/supraventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Supraventricular tachycardia</a></div><div class="field-item odd"><a href="/ecg/aberrant-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Aberrant conduction</a></div><div class="field-item even"><a href="/ecg/fascicular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Fascicular tachycardia</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_3"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fwide-complex-tachycardia-ventricular-tachycardia&amp;title=%20Wide-complex%20Tachycardia%3A%20Ventricular%20Tachycardia"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Tue, 14 Jun 2016 20:23:19 +0000 Dawn 702 at https://www.ecgguru.com https://www.ecgguru.com/ecg/wide-complex-tachycardia-ventricular-tachycardia#comments Bigeminal Rhythm With Aberrant Conduction https://www.ecgguru.com/ecg/bigeminal-rhythm-aberrant-conduction <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/bigeminal-rhythm-aberrant-conduction"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/NSR%20PACs%20Aberr.jpg" width="1800" height="1341" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal">This ECG is a good example of sinus rhythm with aberrantly-conducted PACs.&nbsp; The tracing was donated to the ECG Guru several years ago by Dr. Ahmed from Sanjiban Hospital in India.&nbsp; We have no patient data for this tracing.<span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal">The underlying rhythm here is normal sinus rhythm. Most of the parameters – rate, PR interval, and QRS duration – are normal.&nbsp; The QTc interval, which is the QT interval corrected to a rate of 60 bpm, is prolonged at 568 ms.&nbsp; We do not know the patient’s clinical condition or medications, so we cannot guess at the reason.&nbsp; However, a prolonged QTc is associated with an increased risk of <span style="color: red;"><a href="http://lifeinthefastlane.com/ecg-library/tdp/">Torsades de pointes,</a></span> a type of polymorphic ventricular tachycardia.<span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal">The first three beats appear the same (Leads I, II, and III).&nbsp; However, the first R-to-R interval is shorter than the second one.&nbsp; This could be due to rate variation, a concealed sinus block, or a premature atrial contraction (PAC). &nbsp;&nbsp;The P wave of the “early” beat, marked #1, looks slightly different from the other P waves in Lead II, but, because of the slow rate, there is no way to be sure without a longer rhythm strip.&nbsp; After the possible PAC, the rhythm becomes coupled, probably <span style="color: red;"><a href="http://ecgguru.com/ecg/sinus-rhythm-atrial-bigeminy">atrial bigeminy,</a> </span>where every other beat is a PAC.&nbsp; There are several mechanisms that cause grouped beating, but atrial ectopic bigeminy is the most common. Normally, PACs have different-looking P waves compared to the sinus beats. &nbsp;In this ECG, the P waves are often buried in the preceding T waves, and are hard to evaluate.<span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">Interestingly, the PACs in this strip are conducted with varying amounts of <span style="color: #c00000;"><a href="http://www.metealpaslan.com/ecg/aberasyonen.htm">aberrancy</a>.&nbsp; </span>Because they are premature, they find the ventricles in varying stages of repolarization.&nbsp; When the ventricles are not completely repolarized, the electrical impulse may conduct down the more recovered conduction pathways, while going around the less recovered pathways.&nbsp; A common form of aberrant conduction is <span style="color: #c00000;"><a href="http://ecgguru.com/ecg/instructors-collection-ecg-week-september-23-2015-right-bundle-branch-block-0">right bundle branch block</a></span>.&nbsp; In RBBB aberrant conduction, the impulse finds the right bundle branch temporarily unable to conduct, so it follows the left bundle branch down into the ventricles.&nbsp; The left ventricle is depolarlized slightly ahead of the right, and the common ECG pattern of a wide QRS with rSR’ pattern in V1 and Rs in Leads I and V6 will appear.</span><span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">The PAC marked “2” probably has a small degree of aberrancy.&nbsp; The PACs marked “3” and “4” appear almost like the normal beats.&nbsp; PACs “5” and “6” have clearly taken on the form of right bundle branch block, including the T wave changes commonly seen with RBBB.</span><span style="font-size: 8pt; line-height: 107%;">&nbsp;</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">The clinical significance of the grouped beating, and of the prolonged QT interval, would have to be evaluated before treatment is decided.&nbsp; But, this ECG provides students with a good opportunity to see variations on aberrant conduction.</span></p></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/171/feed" method="post" id="fivestar-custom-widget--4" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--8" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Bigeminal Rhythm With Aberrant Conduction 1/5</option><option value="40">Give Bigeminal Rhythm With Aberrant Conduction 2/5</option><option value="60">Give Bigeminal Rhythm With Aberrant Conduction 3/5</option><option value="80" selected="selected">Give Bigeminal Rhythm With Aberrant Conduction 4/5</option><option value="100">Give Bigeminal Rhythm With Aberrant Conduction 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.5</span></span> <span class="total-votes">(<span >8</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--4" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-g5033Nb6siBiqTxQVtOUcoBx7SGx4GjP8Qou1fwKRAY" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/right-bundle-branch-block-1" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Right bundle branch block</a></div><div class="field-item odd"><a href="/ecg/aberrant-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Aberrant conduction</a></div><div class="field-item even"><a href="/ecg/long-qt-interval" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Long QT interval</a></div><div class="field-item odd"><a href="/ecg/pac" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">PAC</a></div><div class="field-item even"><a href="/ecg/atrial-bigeminy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial bigeminy</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_4"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fbigeminal-rhythm-aberrant-conduction&amp;title=Bigeminal%20Rhythm%20With%20Aberrant%20Conduction"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Thu, 25 Feb 2016 02:09:38 +0000 Dawn 688 at https://www.ecgguru.com https://www.ecgguru.com/ecg/bigeminal-rhythm-aberrant-conduction#comments Anterior-Septal M.I. With Atrial Fibrillation https://www.ecgguru.com/ecg/anterior-septal-mi-atrial-fibrillation <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/anterior-septal-mi-atrial-fibrillation"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AW114%20A%20Fib_0.jpg" width="1800" height="1314" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal">This is an interesting teaching ECG on many levels.&nbsp; It is obtained from a man with chest pain. No other history or follow up is available.<span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal"><strong>Acute M.I. &nbsp; &nbsp;&nbsp;</strong><span style="font-size: 13.008px; line-height: 1.538em;">Most striking is probably the clearly-seen anterior-septal wall M.I.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">There is ST segment elevation in Leads V</span><sub>1</sub><span style="font-size: 13.008px; line-height: 1.538em;">, V</span><sub>2</sub><span style="font-size: 13.008px; line-height: 1.538em;">, and V</span><sub>3</sub><span style="font-size: 13.008px; line-height: 1.538em;">, with ST depression in the low-lateral leads, V</span><sub>5 </sub><span style="font-size: 13.008px; line-height: 1.538em;">and V</span><sub>6</sub><span style="font-size: 13.008px; line-height: 1.538em;">.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">There is also ST depression in the inferior Leads II, III, and aVF.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">The ST elevations have a coved-upward (frown) shape in V</span><sub>1</sub><span style="font-size: 13.008px; line-height: 1.538em;"> and a straight shape in V</span><sub>2</sub><span style="font-size: 13.008px; line-height: 1.538em;"> and V</span><sub>3</sub><span style="font-size: 13.008px; line-height: 1.538em;">.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">Both of these ST shapes are abnormal and reflect injury.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">The depressions are presumed to be due to reciprocal changes, since there is no other ST-depression producing condition apparent.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">There are abnormal Q waves in V</span><sub>1</sub><span style="font-size: 13.008px; line-height: 1.538em;">, which could herald the onset of pathological Q waves, a sign of necrosis, in the anterior-septal wall.</span><span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal"><strong>Atrial Fibrillation &nbsp; &nbsp;&nbsp;</strong><span style="font-size: 13.008px; line-height: 1.538em;">Another very noticeable feature of this ECG is the irregularly-irregular rhythm, with an absence of P waves.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">This is atrial fibrillation with a controlled ventricular response.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">This rate of 72 bpm suggests that the rate has been controlled with medication or that the M.I. has slowed the conduction through the AV node. A fib is significant for this patient because the absence of P waves lowers cardiac output.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">It is more important than ever to keep this patient’s rate controlled, as a fast rate would combine with loss of atrial kick to lower cardiac output and increase myocardial demand – not a good situation for an M.I. patient.</span><span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal"><strong>Incomplete Right Bundle Branch Block &nbsp; &nbsp;&nbsp;</strong><span style="font-size: 13.008px; line-height: 1.538em;">The shape of the QRS in V</span><sub>1</sub><span style="font-size: 13.008px; line-height: 1.538em;"> and V</span><sub>2</sub><span style="font-size: 13.008px; line-height: 1.538em;"> is not typical.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">Those leads should have an rS pattern.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">The qR in V</span><sub>1 </sub><span style="font-size: 13.008px; line-height: 1.538em;">and rSR’ in V2 remind one of the <a title="RBBB" href="http://www.ecgguru.com/ecg/right-bundle-branch-block-2">right bundle branch block</a> pattern, but the QRS is not wide. Leads I and V</span><sub>6 </sub><span style="font-size: 13.008px; line-height: 1.538em;">have narrow s waves, as well.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">This is called “incomplete right bundle branch block”.</span><span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal"><strong>FLB (Funny-looking Beat) &nbsp; &nbsp;&nbsp;</strong><span style="font-size: 13.008px; line-height: 1.538em;">The seventh beat in the strip, marked with an arrow, is different in appearance from all the others.&nbsp; This probably represents aberrant conduction. Usually aberrantly-conducted beats have wide QRS complexes, and this one does not. &nbsp;&nbsp;This different beat ends a short R-to-R cycle which followed a long R-to-R cycle.&nbsp; The refractory period is proportional to the R-to-R interval, becoming longer after a long cycle and shorter after a short cycle.&nbsp; When a long R-to-R interval occurs, the refractory period is lengthened in the next cycle.&nbsp; If that cycle has a short R-to-R, the beat ending the short cycle is more likely to fall into the refractory or relative refractory period.&nbsp; &nbsp;It is interesting, but probably not clinically significant.&nbsp;</span></p></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/171/feed" method="post" id="fivestar-custom-widget--5" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--10" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Anterior-Septal M.I. With Atrial Fibrillation 1/5</option><option value="40">Give Anterior-Septal M.I. With Atrial Fibrillation 2/5</option><option value="60">Give Anterior-Septal M.I. With Atrial Fibrillation 3/5</option><option value="80">Give Anterior-Septal M.I. With Atrial Fibrillation 4/5</option><option value="100" selected="selected">Give Anterior-Septal M.I. With Atrial Fibrillation 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.5</span></span> <span class="total-votes">(<span >6</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--5" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-k6u1V6uEjlsoRUTiQz7W21KnpswMETPzdqzng8ugypc" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/stemi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">STEMI</a></div><div class="field-item odd"><a href="/ecg/anterior-septal-mi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Anterior-septal M.I.</a></div><div class="field-item even"><a href="/ecg/incomplete-right-bundle-branch-block-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Incomplete right bundle branch block</a></div><div class="field-item odd"><a href="/ecg/atrial-fibrillation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial fibrillation</a></div><div class="field-item even"><a href="/ecg/aberrant-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Aberrant conduction</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_5"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fanterior-septal-mi-atrial-fibrillation&amp;title=%20%20Anterior-Septal%20M.I.%20With%20Atrial%20Fibrillation"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sat, 13 Feb 2016 01:33:49 +0000 Dawn 687 at https://www.ecgguru.com https://www.ecgguru.com/ecg/anterior-septal-mi-atrial-fibrillation#comments ECG Basics: Atrial Flutter With 2:1 Conduction And An Aberrantly-conducted Beat https://www.ecgguru.com/ecg/ecg-basics-atrial-flutter-21-conduction-and-aberrantly-conducted-beat <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/ecg-basics-atrial-flutter-21-conduction-and-aberrantly-conducted-beat"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/155%20AFL%202%20to1%20w%20Aberrant%20beat%20MR111.jpg" width="1800" height="410" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This strip was taken from a patient at rest. &nbsp;It shows a regular tachycardia with a slightly-widened QRS complex at about .10 seconds duration. &nbsp;It is somewhat difficult to evaluate the baseline for P waves or flutter waves. &nbsp;We ALWAYS recommend multi-lead assessment for such evaluation. &nbsp;The P waves (or flutter waves) here have a sharp point, and can be easily "marched out", with a rate of about 300 per minute.</p><p>Whenever the ventricular rate is near 150/min., we should always consider the possibility of atrial flutter with 2:1 conduction. &nbsp;Since atrial flutter results in atrial depolarization at around 250 - 350 per minute, conducting every other P wave results in a rate of about 150. &nbsp;It can masquerade as sinus tach, but a patient with sinus tach at such a fast rate would probably have an obvious cause for a rapid heart rate, such as hypovolemia, drug overdose, or exertion. &nbsp;This rhythm could also be mistaken for atrial tachycardia or other forms of supraventricular tachycardia (SVT, PSVT, AVNRT, etc.). &nbsp; Multiple leads can more easily uncover the flutter waves running continuously "behind" and "through" the QRS complexes.</p><p>There is one beat that is obviously different from the others. &nbsp;This beat is about the same width as the other QRS complexes, but is opposite in direction. &nbsp;This probably represents aberrant conduction, possibly a hemiblock that occurs only in this beat. &nbsp;Careful measurement will show that this QRS is very slightly early, while the others are all very regular. The slight width of all the QRS complexes suggests that there is a conduction delay, which cannot be diagnosed on one strip with no patient history available.</p><p>There are other differential diagnoses, such as ventricular tachycardia with a captured sinus beat. &nbsp;We welcome discussion of this interesting strip.&nbsp;</p></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/171/feed" method="post" id="fivestar-custom-widget--6" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--12" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give ECG Basics: Atrial Flutter With 2:1 Conduction And An Aberrantly-conducted Beat 1/5</option><option value="40">Give ECG Basics: Atrial Flutter With 2:1 Conduction And An Aberrantly-conducted Beat 2/5</option><option value="60">Give ECG Basics: Atrial Flutter With 2:1 Conduction And An Aberrantly-conducted Beat 3/5</option><option value="80" selected="selected">Give ECG Basics: Atrial Flutter With 2:1 Conduction And An Aberrantly-conducted Beat 4/5</option><option value="100">Give ECG Basics: Atrial Flutter With 2:1 Conduction And An Aberrantly-conducted Beat 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4</span></span> <span class="total-votes">(<span >2</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--6" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-hOB-X8tLuczUf2zZxAv0ZgPtIH17MdO3Qb9l0-nkfPo" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/atrial-flutter-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial flutter</a></div><div class="field-item odd"><a href="/ecg/atrial-flutter-21-conduction-1" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial flutter with 2:1 conduction</a></div><div class="field-item even"><a href="/ecg/basic-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Basic ECG</a></div><div class="field-item odd"><a href="/ecg/aberrant-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Aberrant conduction</a></div><div class="field-item even"><a href="/ecg/fusion-beat" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Fusion beat</a></div><div class="field-item odd"><a href="/ecg/rhythm-strip" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Rhythm strip</a></div><div class="field-item even"><a href="/ecg/ecg-basics" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ECG Basics</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_6"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fecg-basics-atrial-flutter-21-conduction-and-aberrantly-conducted-beat&amp;title=ECG%20Basics%3A%20%20Atrial%20Flutter%20With%202%3A1%20Conduction%20And%20An%20Aberrantly-conducted%20Beat"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 23 Aug 2015 18:20:06 +0000 Dawn 658 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-atrial-flutter-21-conduction-and-aberrantly-conducted-beat#comments Jason's Blog: ECG Challenge for the month of August, 2013. https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-month-august-2013 <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-month-august-2013"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Month%202q%20ladder%20diagram.png" width="765" height="499" 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>Patient of unknown age and gender with a history of atrial fibrillation.&nbsp; What's your interpretation?</p> </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/171/feed" method="post" id="fivestar-custom-widget--7" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--14" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Jason&amp;#039;s Blog: ECG Challenge for the month of August, 2013. 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge for the month of August, 2013. 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge for the month of August, 2013. 3/5</option><option value="80" selected="selected">Give Jason&amp;#039;s Blog: ECG Challenge for the month of August, 2013. 4/5</option><option value="100">Give Jason&amp;#039;s Blog: ECG Challenge for the month of August, 2013. 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4</span></span> <span class="total-votes">(<span >6</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--7" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-CmzJo1MrcxYG_VA874x9L49JhCvo-3ZmszgSiUA04lM" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_7"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fblog%2Fjasons-blog-ecg-challenge-month-august-2013&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20for%20the%20month%20of%20August%2C%202013."><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Wed, 07 Aug 2013 01:25:32 +0000 jer5150 478 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-month-august-2013#comments Spontaneously Changing Conduction In Wide Complex Tachycardia https://www.ecgguru.com/ecg/spontaneously-changing-conduction-wide-complex-tachycardia <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/spontaneously-changing-conduction-wide-complex-tachycardia"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Arnel%20Carmona%20svt%20with%20normalization.jpg" width="1800" height="1196" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal" style="text-align: left;"><span style="font-family: 'Arial','sans-serif';"><strong>This ECG was donated to the ECG Guru by Dr. Arnel Carmona, one of our favorite Gurus. &nbsp;You will not often see such a great example of this. &nbsp;We are very grateful to Dr. Carmona for his contribution to learning.</strong></span><span style="font-family: 'Arial','sans-serif';"><strong>&nbsp;Dr. Carmona's new blog is&nbsp;<a title="EZG" href="%20%20http://ezgecg.blogspot.com/%20%20%20">EZG</a> - ECG for beginners and enthusiasts.&nbsp;&nbsp;&nbsp;&nbsp;</strong></span></p><p class="MsoNormal" style="text-align: left;"><strong style="font-family: Arial, sans-serif; line-height: 1.538em;">An adult patient was admitted due to palpitations.&nbsp; What is this rhythm?</strong><span style="font-family: Arial, sans-serif; line-height: 1.538em;">This is a tachyarrhythmia that initially is regular wide complex (RBB morphology) and later became regular narrow complex at a rate of about 187 bpm. There is normalization of the QRS without a change in heart rate. In the latter part of the tracing (narrow complex), pseudo-r can be seen in V1. So, this is SVT with aberrancy with spontaneous normalization.</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal; mso-layout-grid-align: none; text-autospace: none;"><strong><span style="font-size: 10.0pt; font-family: 'Arial','sans-serif';">What is the cause of the intraventricular aberration during acceleration of heart rate?</span></strong><span style="font-family: Arial, sans-serif; font-size: 10pt;">&nbsp;</span><span style="font-size: 10.0pt; font-family: 'Arial','sans-serif';">It could be due to failure of the refractory period to shorten or possible lengthening in response to acceleration.</span><span style="font-family: Arial, sans-serif; font-size: 10pt;">&nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal; mso-layout-grid-align: none; text-autospace: none;"><strong><span style="font-size: 10.0pt; font-family: 'Arial','sans-serif';">What is the cause of the normalization of the of the QRS?</span></strong><span style="font-family: Arial, sans-serif; font-size: 10pt;">&nbsp;</span><span style="font-size: 10.0pt; font-family: 'Arial','sans-serif';">The normalization of intraventricular conduction could be due to the gradual shortening of bundle branch refractory period in response to the tachycardia.</span><span style="font-family: Arial, sans-serif; font-size: 10pt;">&nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal; mso-layout-grid-align: none; text-autospace: none;"><strong><span style="font-size: 10.0pt; font-family: 'Arial','sans-serif';">What is the possible mechanism maintaining the aberration?</span></strong><span style="font-family: Arial, sans-serif; font-size: 10pt;">&nbsp;</span><span style="font-size: 10.0pt; font-family: 'Arial','sans-serif';">It is likely due to the transeptal concealed conduction blocking conduction in the contralateral bundle. With dissipation of transeptal conduction, the QRS complex normalizes.</span><span style="font-family: Arial, sans-serif; font-size: 10pt;">&nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal; mso-layout-grid-align: none; text-autospace: none;"><strong><span style="font-size: 10pt; font-family: Arial, sans-serif;">What happened to the case?</span><span style="font-family: Arial, sans-serif; font-size: 10pt;">&nbsp;</span></strong><span style="font-family: Arial, sans-serif; font-size: 10pt;">Adenosine was given, terminating the arrhythmia.</span><span style="font-size: 10.0pt; font-family: 'Arial','sans-serif';">&nbsp;</span><span style="font-size: 10pt; font-family: Arial, sans-serif;">&nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal; mso-layout-grid-align: none; text-autospace: none;"><span style="font-size: 10.0pt; font-family: 'Arial','sans-serif';">Ref:</span><span style="font-family: Arial, sans-serif; font-size: 10pt;">&nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal; mso-layout-grid-align: none; text-autospace: none;"><span style="font-size: 10.0pt; font-family: 'Arial','sans-serif';">Fisch C. 1983. Aberration : Seventy-five years after Sir Thomas Lewis. BHJ 50:297-302</span><span style="font-family: Arial, sans-serif; font-size: 10pt;">&nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal; mso-layout-grid-align: none; text-autospace: none;"><span style="font-family: Arial, sans-serif; font-size: 10pt;">Fisch C and Knoebel SB. 2000. Electrocardiography of Clinical Arrhythmia. New York. Futura Publishing Co</span></p><p class="MsoNormal"><span style="font-family: 'Arial','sans-serif';">&nbsp;</span></p><p class="MsoNormal"><span style="font-family: 'Arial','sans-serif';">&nbsp;</span></p></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/171/feed" method="post" id="fivestar-custom-widget--8" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--16" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Spontaneously Changing Conduction In Wide Complex Tachycardia 1/5</option><option value="40">Give Spontaneously Changing Conduction In Wide Complex Tachycardia 2/5</option><option value="60">Give Spontaneously Changing Conduction In Wide Complex Tachycardia 3/5</option><option value="80">Give Spontaneously Changing Conduction In Wide Complex Tachycardia 4/5</option><option value="100" selected="selected">Give Spontaneously Changing Conduction In Wide Complex Tachycardia 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.2</span></span> <span class="total-votes">(<span >5</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--8" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-pQ-_fFupicCv01EH4EWmbWS8lU6BXBYs4-N-CX4R3AQ" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/aberrant-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Aberrant conduction</a></div><div class="field-item odd"><a href="/ecg/tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Tachycardia</a></div><div class="field-item even"><a href="/ecg/wide-complex-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wide complex tachycardia</a></div><div class="field-item odd"><a href="/ecg/spontaneous-change-aberrant-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Spontaneous change from aberrant conduction</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_8"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fspontaneously-changing-conduction-wide-complex-tachycardia&amp;title=Spontaneously%20Changing%20Conduction%20In%20Wide%20Complex%20Tachycardia"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Thu, 11 Apr 2013 04:23:46 +0000 Dawn 432 at https://www.ecgguru.com https://www.ecgguru.com/ecg/spontaneously-changing-conduction-wide-complex-tachycardia#comments Normal Sinus Rhythm With Aberrantly-Conducted PACs https://www.ecgguru.com/ecg/normal-sinus-rhythm-aberrantly-conducted-pacs <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/normal-sinus-rhythm-aberrantly-conducted-pacs"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/NRB100_0.jpg" width="1400" height="940" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This is a normal 12-Lead ECG with two PACs that are aberrantly conducted in a right bundle branch block pattern. (Sixth and ninth beats). In the PACs, the QRS is slightly wider than the normal beats.&nbsp; The aberrantly-conducted beats have an rsR' pattern in V1, and a wide little S wave in aVL. No PACs are seen in Lead I to demonstrate the wide S wave.&nbsp; This represents a right bundle branch block pattern, which is a common form of aberrancy, and is rate-related.&nbsp; That is, the PAC occurs early in the cycle, catching the right bundle branch is a refractory state and unable to depolarize.&nbsp; Slower beats are easily&nbsp;acommodated by the right bundle branch.</p></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/171/feed" method="post" id="fivestar-custom-widget--9" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--18" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Normal Sinus Rhythm With Aberrantly-Conducted PACs 1/5</option><option value="40">Give Normal Sinus Rhythm With Aberrantly-Conducted PACs 2/5</option><option value="60">Give Normal Sinus Rhythm With Aberrantly-Conducted PACs 3/5</option><option value="80">Give Normal Sinus Rhythm With Aberrantly-Conducted PACs 4/5</option><option value="100" selected="selected">Give Normal Sinus Rhythm With Aberrantly-Conducted PACs 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.6</span></span> <span class="total-votes">(<span >8</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--9" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-uK8lzSSo9cdl4cadhm285Grz1W52LrXKzRqtidkfE8U" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/aberrant-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Aberrant conduction</a></div><div class="field-item odd"><a href="/ecg/right-bundle-branch-block-1" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Right bundle branch block</a></div><div class="field-item even"><a href="/ecg/rbbb" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">RBBB</a></div><div class="field-item odd"><a href="/ecg/bundle-branch-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Bundle branch block</a></div><div class="field-item even"><a href="/ecg/pac" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">PAC</a></div><div class="field-item odd"><a href="/ecg/premature-atrial-contraction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Premature atrial contraction</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_9"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fnormal-sinus-rhythm-aberrantly-conducted-pacs&amp;title=Normal%20Sinus%20Rhythm%20With%20Aberrantly-Conducted%20PACs%20"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Wed, 03 Apr 2013 04:00:00 +0000 Dawn 155 at https://www.ecgguru.com https://www.ecgguru.com/ecg/normal-sinus-rhythm-aberrantly-conducted-pacs#comments PACs With Left Anterior Fascicular Block Aberrancy https://www.ecgguru.com/ecg/pacs-left-anterior-fascicular-block-aberrancy <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/pacs-left-anterior-fascicular-block-aberrancy"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/12.%20PACLAH100.jpg" width="1800" height="1123" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>A good example of aberrantly conducted premature beats (PACs or possibly PJCs) that are conducted with a left anterior fascicular block.&nbsp; The underlying rhythm is sinus at about 80/min.&nbsp; The timing of the premature beats is best seen in the Lead II rhythm strip at the bottom, as this ECG machine does not print the 12 leads in an uninterrupted manner.&nbsp; You will see interruptions each time the leads change.</p><p>The first beat on the ECG is one of the premature beats.&nbsp; You can observe the left axis deviation without pathological Q waves.&nbsp; Lead I shows the premature beats with an Rs pattern, and Leads II and&nbsp;III have rS.&nbsp; The early beats have caught the anterior fascicle of the left bundle branch refractory from the preceding beat.&nbsp; It recovers for the normally-timed&nbsp;sinus beats.</p></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/171/feed" method="post" id="fivestar-custom-widget--10" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--20" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give PACs With Left Anterior Fascicular Block Aberrancy 1/5</option><option value="40">Give PACs With Left Anterior Fascicular Block Aberrancy 2/5</option><option value="60">Give PACs With Left Anterior Fascicular Block Aberrancy 3/5</option><option value="80">Give PACs With Left Anterior Fascicular Block Aberrancy 4/5</option><option value="100">Give PACs With Left Anterior Fascicular Block Aberrancy 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="empty">No votes yet</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--10" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-A5oWCrr9JC_snGi0RAMiCtkKbCUFWTSRbr8J1-nMiQ4" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/aberrant-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Aberrant conduction</a></div><div class="field-item odd"><a href="/ecg/pac" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">PAC</a></div><div class="field-item even"><a href="/ecg/premature-atrial-contraction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Premature atrial contraction</a></div><div class="field-item odd"><a href="/ecg/left-anterior-fascicular-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left anterior fascicular block</a></div><div class="field-item even"><a href="/ecg/left-anterior-hemiblock" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left anterior hemiblock</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_10"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fpacs-left-anterior-fascicular-block-aberrancy&amp;title=PACs%20With%20Left%20Anterior%20Fascicular%20Block%20Aberrancy"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Tue, 09 Oct 2012 01:08:20 +0000 Dawn 347 at https://www.ecgguru.com https://www.ecgguru.com/ecg/pacs-left-anterior-fascicular-block-aberrancy#comments