ECG Guru - Instructor Resources - Tachycardia https://www.ecgguru.com/ecg/tachycardia en Sinus Tachycardia https://www.ecgguru.com/ecg/sinus-tachycardia-0 <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/sinus-tachycardia-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Sinus100.jpg" width="1800" height="1210" 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 collection of tracings that, sadly, have no patient information.<span style="mso-spacerun: yes;">&nbsp; </span>It is interesting nonetheless, and we would love to hear your thoughts on it.</p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="color: #00b050;">ECG Findings:<span style="mso-spacerun: yes;">&nbsp; </span></span>The rhythm </strong>is sinus tachycardia, at a rate of 120 bpm.<span style="mso-spacerun: yes;">&nbsp; </span>The QRS is narrow at .08 seconds (82 ms).<span style="mso-spacerun: yes;">&nbsp; </span>While the <strong style="mso-bidi-font-weight: normal;">PR interval</strong> is normal, at .14 seconds (140 ms), the <strong style="mso-bidi-font-weight: normal;">PR segment</strong> is very short. The PR segment is the line between the end of the P wave to the beginning of the QRS complex.<span style="mso-spacerun: yes;">&nbsp; </span>This can indicate the presence of an accessory pathway that bypasses the AV node, or of faster conduction within the AV node. The P waves in the inferior leads II, III, and aVF barely meet voltage criteria for right atrial enlargement, <span style="mso-spacerun: yes;">&nbsp;</span>but the P waves in V1 do not have the usual prominent positive deflection one would expect with RAE.<span style="mso-spacerun: yes;">&nbsp; </span>Even with the short PR segment, the segment appears to be elevated in the inferior leads, without any reciprocal PR depression.<span style="mso-spacerun: yes;">&nbsp; </span>The PR segment is where atrial repolarization occurs (the atrial “T” wave). There are many conditions that can elevate or depress PR segments, and without a patient story here, we can’t guess at the cause.<span style="mso-spacerun: yes;">&nbsp; </span>If you are an instructor, this would be a good ECG to illustrate why we use the TP segment to determine the “isoelectric line”, rather than the PR segment.</p><p class="MsoNormal">The inferior <strong style="mso-bidi-font-weight: normal;">ST segments</strong> are very flat, which is not normal, while the rest of the ST segments display the normal concave up “smile” shape.<span style="mso-spacerun: yes;">&nbsp; </span>Serial ECGs would no doubt be helpful here, to recognize changes in the ST segments.</p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="color: #00b050;">Bottom Line</span></strong><span style="color: #00b050;">: </span><span style="mso-spacerun: yes;">&nbsp;</span>It would be much easier to make a determination about the causes of these subtle changes if we had patient information.<span style="mso-spacerun: yes;">&nbsp; </span>However, this ECG is still valuable as an exercise in measuring intervals, and as an example of short PR segment. It is also a good example of a fairly fast sinus tachycardia.<span style="mso-spacerun: yes;">&nbsp; </span>We would love to hear our visitors’ thoughts on this tracing.</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/23/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 Sinus Tachycardia 1/5</option><option value="40">Give Sinus Tachycardia 2/5</option><option value="60">Give Sinus Tachycardia 3/5</option><option value="80" selected="selected">Give Sinus Tachycardia 4/5</option><option value="100">Give Sinus Tachycardia 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.3</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" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-rMWSbejdiH8NzfuyCZQ521-uf-z9yWM6BtIX-yfMGeQ" /> <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/sinus-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Sinus tachycardia</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/pr-segment" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">PR segment</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%2Fsinus-tachycardia-0&amp;title=Sinus%20Tachycardia"><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> Thu, 10 Oct 2019 02:42:23 +0000 Dawn 777 at https://www.ecgguru.com https://www.ecgguru.com/ecg/sinus-tachycardia-0#comments Tachycardia In An Unresponsive Patient https://www.ecgguru.com/ecg/tachycardia-unresponsive-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/tachycardia-unresponsive-patient"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Tachycardia%20and%20Hyperkalemia.jpg" width="1800" height="713" 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 style="mso-bidi-font-weight: normal;">&nbsp;</strong><strong style="font-size: 13.008px;"><span style="font-size: 10.0pt; line-height: 107%; color: #00b050;">The Patient</span></strong><span style="font-size: 10pt; line-height: 107%; color: #00b050;">&nbsp;&nbsp;&nbsp;&nbsp; </span><span style="font-size: 10pt; line-height: 107%;">This ECG was obtained from a 28-year-old woman who was found in her home, unresponsive.&nbsp; She was hypotensive at 99/35.&nbsp; No one was available to provide information about past medical history or the onset of this event.</span></p><p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">Before you read my comments, pause to look at the ECG and see what YOU think.<span style="mso-spacerun: yes;">&nbsp; </span>We would welcome comments below from all our members!</span></p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; line-height: 107%; color: #00b050;">The ECG</span></strong><span style="font-size: 10.0pt; line-height: 107%; color: #00b050;"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span></span><span style="font-size: 10.0pt; line-height: 107%;">This ECG is quite challenging, as it illustrates the helpfulness of ECG changes in patient diagnosis, and also points out how important clinical correlation is when the ECG suggests multiple different problems. Forgive me in advance, but there is a lot to say about this ECG.</span></p><p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">The <strong style="mso-bidi-font-weight: normal;">heart rate</strong> is 148 bpm, and the <strong style="mso-bidi-font-weight: normal;">rhythm is regular</strong>, although not perfectly. <strong style="mso-bidi-font-weight: normal;">P waves</strong> are not seen, even though the ECG machine gives a P wave axis and PR interval measurement. The rate is fast enough to bury the P waves in the preceding T waves, especially if there is first-degree AV block. <strong style="mso-bidi-font-weight: normal;"><em style="mso-bidi-font-style: normal;"><span style="color: #7030a0;">Differential dx</span></em></strong><em style="mso-bidi-font-style: normal;"><span style="color: #7030a0;">:</span></em><span style="color: #7030a0;"> sinus tachycardia, PSVT, atrial flutter. </span>The very slight irregularity points more towards sinus tachycardia.<span style="mso-spacerun: yes;">&nbsp; </span>The rate of nearly 150 suggests atrial flutter with 2:1 conduction, but the only lead that looks remotely like it has flutter waves is V2. The lack of an onset or offset of the rhythm makes it difficult to diagnose PSVT with any certainty. </span></p><p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">The ECG machine measures the QRS complex at .102 seconds (102 ms). I don’t believe this is correct, as the QRS has an additional wave due to <strong style="mso-bidi-font-weight: normal;"><a href="https://www.ecgguru.com/ecg/instructors-collection-ecg-week-september-23-2015-right-bundle-branch-block-0">right bundle branch block pattern</a></strong>, and the machine did not count this terminal wave.<span style="mso-spacerun: yes;">&nbsp; </span>I measure the actual <strong style="mso-bidi-font-weight: normal;">QRS duration</strong> at closer to .12 seconds (120 ms).<span style="mso-spacerun: yes;">&nbsp; </span>The J point, or end point of the QRS complex, is difficult to see in most of the leads because of slurring from the QRS to the ST segment.<span style="mso-spacerun: yes;">&nbsp; </span></span></p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><em style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; line-height: 107%; color: #7030a0;">Differential dx:</span></em></strong><span style="font-size: 10.0pt; line-height: 107%;"><span style="mso-spacerun: yes;">&nbsp;&nbsp; </span>There are some signs of <strong style="mso-bidi-font-weight: normal;"><a href="https://litfl.com/ecg-changes-in-pulmonary-embolism/">right ventricular failure</a></strong> on this ECG, but ECG is not 100% accurate for determining right heart strain. The ECG evidence must be confirmed by clinical correlation. <span style="mso-spacerun: yes;">&nbsp;</span>In a young person with sudden onset of right heart failure signs, one must consider <strong style="mso-bidi-font-weight: normal;">pulmonary embolus</strong>.<span style="mso-spacerun: yes;">&nbsp; </span>Some, but not all, of the ECG signs that can be associated with pulmonary embolism are:</span></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l1 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Sinus tachycardia (44%)</span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l1 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Right bundle branch block or incomplete RBBB (18%)</span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l1 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Right ventricular strain: T wave inversion in right precordial leads and inferior leads (only present here in V1 and Lead III, which is often normal).</span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l1 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Right axis deviation (16%).<span style="mso-spacerun: yes;">&nbsp; </span>Present here, but not severe at around 100 degrees.</span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l1 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">S1 – Q3 – T3 the “classic” but not often present, sign of pulmonary embolism.<span style="mso-spacerun: yes;">&nbsp; </span>The<span style="mso-spacerun: yes;">&nbsp; </span>S wave in I may simply be the RBBB and the Q wave with T wave inversion may be a normal variant.</span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l1 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Non-specific ST segment and T wave changes (50%)</span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l1 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">P pulmonale (we cannot see P waves)</span></p><p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">There are also ST and T wave changes that resemble <strong style="mso-bidi-font-weight: normal;"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6282764/">Brugada Syndrome</a>, </strong>a genetic disorder of the sodium channel that can cause sudden death.<span style="mso-spacerun: yes;">&nbsp; </span>Illness can unmask the ECG changes that point to Brugada syndrome, but also there are conditions that cause similar ECG changes without the patient actually having a channelopathy. The shape of the ST and inverted T wave in V1 here are “Brugada like”. In Brugada Syndrome, those changes are usually seen in V1 and V2.<span style="mso-spacerun: yes;">&nbsp; </span></span></p><p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">The loss of P waves and the tall, peaked T waves with narrow bases are indicative of <strong style="mso-bidi-font-weight: normal;"><a href="https://rebelem.com/ecg-changes-hyperkalemia/">hyperkalemia</a></strong>. It is difficult to determine just from the ECG how far along the patient is in serum potassium levels, but widening of the QRS with loss of voltage is a dire sign.<span style="mso-spacerun: yes;">&nbsp; </span>Because hyperkalemia can progress swiftly to a “sine wave” pattern, it is crucial to make the diagnosis and begin treatment as soon as possible.<span style="mso-spacerun: yes;">&nbsp; </span>Usually, the serum K is high because the K has moved out of the intracellular space and entered the serum. Rather than remove K from the body, it is necessary to “push” it back into the cells, where it rightly belongs.<span style="mso-spacerun: yes;">&nbsp; </span></span></p><p class="MsoNormal" style="margin-bottom: .0001pt;"><span style="font-size: 10.0pt; line-height: 107%;">And, to make matters even more confusing, this ECG show signs of drug toxicity, specifically <strong style="mso-bidi-font-weight: normal;"><a href="https://litfl.com/tricyclic-overdose-sodium-channel-blocker-toxicity/">sodium channel blocker overdose</a>.<span style="mso-spacerun: yes;">&nbsp; </span></strong>Tricyclic antidepressants and some antiarrhythmics fall into this broad category. <span style="mso-spacerun: yes;">&nbsp;</span>Remember, this patient was found unresponsive, and we have no remote OR recent medical history.<span style="mso-spacerun: yes;">&nbsp; </span>Everything is on the table.<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span><span style="mso-spacerun: yes;">&nbsp;</span>ECG signs of sodium channel blocker OD include:</span></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo2;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Sinus tachycardia</span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo2;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Wide QRS complex</span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo2;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Prolongation of the PR interval or QT interval</span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo2;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Right bundle branch block</span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo2;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Brugada pattern</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; color: #00b050;">Hospital Follow Up<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span></span></strong><span style="font-size: 10.0pt;">At this time, we have only a preliminary follow up report.<span style="mso-spacerun: yes;">&nbsp; </span>Notably, this young woman was found to be in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298445/">diabetic ketoacidosis</a>, with a blood glucose level of 1,332 mg/dL! As a result, she was also hyperkalemic, with a serum potassium of 8.2.<span style="mso-spacerun: yes;">&nbsp; </span>The severe dehydration and acidosis of DKA cause sinus tachycardia.</span></p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><em style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; line-height: 107%; color: #595959; mso-themecolor: text1; mso-themetint: 166; mso-style-textfill-fill-color: #595959; mso-style-textfill-fill-themecolor: text1; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: 'lumm=65000 lumo=35000';">Thanks to Sebastian Garay for donating this interesting ECG.</span></em></strong></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/23/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 Tachycardia In An Unresponsive Patient 1/5</option><option value="40">Give Tachycardia In An Unresponsive Patient 2/5</option><option value="60">Give Tachycardia In An Unresponsive Patient 3/5</option><option value="80" selected="selected">Give Tachycardia In An Unresponsive Patient 4/5</option><option value="100">Give Tachycardia In An Unresponsive Patient 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.6</span></span> <span class="total-votes">(<span >16</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-NhxdnRFzyzY7xOL4XE1C9Fiz11AHz4MFkMhSTI0nwIA" /> <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/tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Tachycardia</a></div><div class="field-item odd"><a href="/ecg/sinus-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Sinus tachycardia</a></div><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/bifascicular-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Bifascicular block</a></div><div class="field-item even"><a href="/ecg/left-posterior-hemiblock" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left posterior hemiblock</a></div><div class="field-item odd"><a href="/ecg/right-axis-deviation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Right axis deviation</a></div><div class="field-item even"><a href="/ecg/sa-exit-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">SA exit block</a></div><div class="field-item odd"><a href="/ecg/wide-qrs-complex" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wide QRS complex</a></div><div class="field-item even"><a href="/ecg/diabetic-ketoacidosis" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Diabetic ketoacidosis</a></div><div class="field-item odd"><a href="/ecg/hyperkalemia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Hyperkalemia</a></div><div class="field-item even"><a href="/ecg/brugada-sign" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Brugada sign</a></div><div class="field-item odd"><a href="/ecg/tricyclic-antidepressant-overdose" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Tricyclic antidepressant overdose</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%2Ftachycardia-unresponsive-patient&amp;title=Tachycardia%20In%20An%20Unresponsive%20Patient"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Wed, 21 Aug 2019 02:48:51 +0000 Dawn 775 at https://www.ecgguru.com https://www.ecgguru.com/ecg/tachycardia-unresponsive-patient#comments Syncope and tachycardia https://www.ecgguru.com/ecg/syncope-and-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/syncope-and-tachycardia"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/MR112%20Wide%20complex%20rhythm.jpg" width="2000" height="765" 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 is taken from a 55-year-old man whose wife called 911 because he had a syncopal episode.&nbsp; When the paramedics arrived, he was conscious and alert, and denied any symptoms.&nbsp; He gave a history of "cardiac", diabetes, and opiate abuse.&nbsp; We do not know the nature of his cardiac history or his medications.&nbsp;&nbsp;</p><p>It is difficult to pinpoint a definite diagnosis with this lack of information and a clearly abnormal ECG.&nbsp; We will limit our discussion to listing the abnormalities seen:</p><p><strong>The ECG rhythm:</strong>&nbsp; There is a fast, regular rhythm that is supraventricular in origin (there are P waves).&nbsp; When a supraventricular rhythm has a rate of about 150 per minute, we should ALWAYS consider ATRIAL FLUTTER WITH 2:1 CONDUCTION.&nbsp; Atrial flutter produces P waves (flutter waves) at approximately 250-350 per minute.&nbsp; The normal AV node is able to conduct half of these, at a rate of about 150 per minute. Atrial flutter with 2:1 conduction is the most common presentation of new-onset atrial flutter.&nbsp; It is often missed by people who expect to see several flutter waves in a row, producing the "sawtooth pattern".&nbsp; That being said, atrial flutter is usually discernable in at least a few leads if it is present.&nbsp; We do not see any signs of flutter waves in this ECG.</p><p>That leaves us with a differential diagnosis of sinus tachycardia vs. one of the regular supraventricular tachycardias like reentrant tachycardias or atrial tachycardia.&nbsp; Sinus tachycardia can be recognized by several features. If we are fortunate enough to witness the onset or offset of the fast rhythm, will will recognize sinus tachycardia by a "warm up" or gradual speeding up of the rate, and a "cool down", or gradual slowing.&nbsp; On the other hand, SVTs often have abrupt onset and offset.&nbsp; Sinus tachycardia often has a very obvious cause, such as hypovolemia, fever, pain, anxiety, vigorous exercise, or hypoxia.&nbsp; Sinus tachycardia usually has a distinct, upright P wave in Lead II, and a clearly-seen, often negative, P wave in Lead V1.&nbsp; This ECG does not show the onset of the tachycardia, and is not long enough to evaluate for rate changes. Lead II appears to have upright P waves on the downslope of the previous T waves. V1 has deeply negative P waves, and V4 has the most clearly-seen P waves.&nbsp; Without being positive, this looks more like sinus tachycardia than a reentrant tachycardia.&nbsp; It would help to know more about the patient's condition.</p><p><strong>The QRS complexes:</strong>&nbsp; The QRS complexes are slightly wide at .106 seconds.&nbsp; This is not wide enough to consider bundle branch block.&nbsp; Other conditions can cause widening, such as left ventricular hypertrophy and hemiblock, as well as some drug and electrolyte effects.&nbsp; The frontal plane axis is abnormally leftward, which supports a left anterior hemiblock (left anterior fascicular block) diagnosis. There is not a distinct qR pattern in Lead I or rS in Lead III, however.&nbsp; Lead aVF appears to have a pathological Q wave - could this be why Lead III does not have a distinct r wave?&nbsp; &nbsp;</p><p>While the chest leads do not show increased voltage that would indicate left ventricular hypertrophy, the left axis and the tall QRS in aVL do meet the criteria for LVH.&nbsp; LVH is not diagnosed by ECG, but it does cause changes on the ECG, such as increased voltage in left-sided leads and a "strain" pattern.&nbsp; Leads I and aVL demonstrate the strain pattern of downsloping ST segments and T wave inversion, but the chest leads do not.&nbsp; &nbsp;</p><p>The QRS complexes in V2, V3, and V4 are fragmented, which is an equivalent to pathological Q wave.&nbsp; This may indicate a prior anterior wall M.I.&nbsp; There is very slight J-point elevation in the right-sided chest leads, but may be due to LVH.</p><p>Without knowing more about this patient's past medical history, or the results of his physical exam, it is difficult to assign meaning to all these abnormal findings.&nbsp; It is unfortunate that he refused transport to a hospital, and we can only hope that he later found his way there for treatment.</p><p>Many thanks to Jon Hamilton for donating this ECG to the ECG Guru</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/23/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 Syncope and tachycardia 1/5</option><option value="40">Give Syncope and tachycardia 2/5</option><option value="60">Give Syncope and tachycardia 3/5</option><option value="80">Give Syncope and tachycardia 4/5</option><option value="100" selected="selected">Give Syncope and tachycardia 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.4</span></span> <span class="total-votes">(<span >7</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-gLdIBICPHN3FBR_R2DXtfBXKqDFhWflsDOYmPEVt-Sc" /> <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/tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Tachycardia</a></div><div class="field-item odd"><a href="/ecg/wide-qrs" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wide QRS</a></div><div class="field-item even"><a href="/ecg/lad" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">LAD</a></div><div class="field-item odd"><a href="/ecg/left-axis-deviation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left axis deviation</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 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/sinus-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Sinus 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%2Fsyncope-and-tachycardia&amp;title=Syncope%20and%20tachycardia"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Mon, 14 Jan 2019 04:32:51 +0000 Dawn 763 at https://www.ecgguru.com https://www.ecgguru.com/ecg/syncope-and-tachycardia#comments Paroxysmal Supraventricular Tachycardia https://www.ecgguru.com/ecg/instructors-collection-ecg-week-april-12-2015-paroxysmal-supraventricular-tachycardia-0 <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/instructors-collection-ecg-week-april-12-2015-paroxysmal-supraventricular-tachycardia-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/SVT100_0.jpg" width="1400" height="925" 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 style="margin: 0in 0in 15pt; line-height: 13.3pt; background-image: initial; background-attachment: initial; background-size: initial; background-origin: initial; background-clip: initial; background-position: initial; background-repeat: initial;"><span style="font-size: 10pt; font-family: Verdana, sans-serif;">This ECG is from a man in his 60's who is experiencing chest discomfort and palpitations.&nbsp; The onset of the rapid heart rate and the symptoms was sudden, while he was at rest.&nbsp; The rate did not slow when he was placed on oxygen,&nbsp;given IV fluids,&nbsp;and rested further. The rate is 177 / min.&nbsp;&nbsp;</span></p><p style="margin: 0in 0in 15pt; line-height: 13.3pt; outline: 0px; font-stretch: inherit; background-image: initial; background-attachment: initial; background-size: initial; background-origin: initial; background-clip: initial; background-position: initial; background-repeat: initial;"><span style="font-size: 10pt; font-family: Verdana, sans-serif;">The rhythm is </span><strong><span style="font-size: 10.0pt; font-family: 'Verdana',sans-serif; color: #00b050;">AV nodal reentry tachycardia (AVNRT)</span></strong><span style="font-size: 10pt; font-family: Verdana, sans-serif;">, which is one of the rhythms that falls into the category of paroxysmal supraventricular tachycardia </span><strong><span style="font-size: 10.0pt; font-family: 'Verdana',sans-serif; color: #00b050;">(PSVT).</span></strong><span style="font-size: 10pt; font-family: Verdana, sans-serif;">We can see signs of <em>retrograde P waves</em> in some leads (II, III, aVF, V1). &nbsp;AVNRT is caused by a reentry circuit in the AV node.</span></p><p>&nbsp;</p><p style="margin: 0in 0in 15pt; line-height: 13.3pt; outline: 0px; font-stretch: inherit; background-image: initial; background-attachment: initial; background-size: initial; background-origin: initial; background-clip: initial; background-position: initial; background-repeat: initial;"><span style="font-size: 10pt; font-family: Verdana, sans-serif;">Some instructors teach students that sinus tach is approximately 100-150 per minute, and atrial tach is usually 150-250 per minute. &nbsp;If students only learn about differentiating these two rhythms by the rate difference, it will cause later problems. &nbsp;Of course, there is actually an overlap in rates between the two rhythms. &nbsp;For example, a febrile, dehydrated infant could easily reach this rate and be in sinus rhythm.&nbsp; A young, healthy person on a treadmill could, too.&nbsp; Clues to the ectopic origin of this rhythm are:&nbsp; sudden onset (unfortunately, not witnessed here), regular rhythm with unwaivering rate, and the patient's situation (symptoms while at rest, no obvious reason for sinus tach).&nbsp; Of course,&nbsp;we need to teach to the level of our students' abilities.&nbsp; Consider whether they just memorizing rhythms criteria now, or are they learning about re-entry?</span></p><p style="margin: 0in 0in 15pt; line-height: 13.3pt; outline: 0px; font-stretch: inherit; background-image: initial; background-attachment: initial; background-size: initial; background-origin: initial; background-clip: initial; background-position: initial; background-repeat: initial;"><span style="font-size: 10pt; font-family: Verdana, sans-serif;">There are many different mechanisms of supraventricular tachycardia, and they differ on an electrophysiologic basis. &nbsp;Depending upon the level of your students, you will have to decide how much detail to teach. &nbsp;There are many resources on this site, including the <a title="ECG Archives" href="http://www.ecgguru.com/ecg">ECG Archives</a>, <a href="http://www.ecgguru.com/ask-the-expert">Ask the Expert</a>, <a title="Jasons Blog" href="http://www.ecgguru.com/blogs/jer5150">Jason's Blog</a>, and <a title="Favorite Sites" href="http://www.ecgguru.com/here-are-some-links-you-might-find-helpful">Favorite Sites</a> that will help you if you want to go into more detail. &nbsp;For many health care providers, the entire category of "PSVT" is treated the same initially, and there is no need to differentiate the types of PSVT.</span></p><p style="margin: 0in 0in 15pt; line-height: 13.3pt; outline: 0px; font-stretch: inherit; background-image: initial; background-attachment: initial; background-size: initial; background-origin: initial; background-clip: initial; background-position: initial; background-repeat: initial;"><span style="font-size: 10pt; font-family: Verdana, sans-serif;"><br /></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/23/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 Paroxysmal Supraventricular Tachycardia 1/5</option><option value="40">Give Paroxysmal Supraventricular Tachycardia 2/5</option><option value="60">Give Paroxysmal Supraventricular Tachycardia 3/5</option><option value="80" selected="selected">Give Paroxysmal Supraventricular Tachycardia 4/5</option><option value="100">Give Paroxysmal Supraventricular Tachycardia 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.8</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--4" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-z8bk2BVFUUBNeXjdw81YCG5qATNj_1hvyeFnLyEnlmU" /> <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/paroxysmal-supraventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Paroxysmal supraventricular tachycardia</a></div><div class="field-item odd"><a href="/ecg/avnrt" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">AVNRT</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/tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">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_4"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Finstructors-collection-ecg-week-april-12-2015-paroxysmal-supraventricular-tachycardia-0&amp;title=Paroxysmal%20Supraventricular%20Tachycardia"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 12 Apr 2015 19:59:34 +0000 Dawn 633 at https://www.ecgguru.com https://www.ecgguru.com/ecg/instructors-collection-ecg-week-april-12-2015-paroxysmal-supraventricular-tachycardia-0#comments Ventricular Tachycardia https://www.ecgguru.com/ecg/ventricular-tachycardia-2 <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/ventricular-tachycardia-2"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/WCT103.jpg" width="1800" height="1065" 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><span style="font-size: 13.0080003738403px; line-height: 20.0063037872314px;">This wide-complex tachycardia is ventricular tachycardia.&nbsp; Along with the wide QRS and the fast rate, features which favor a diagnosis of VT over BBB include:&nbsp; backwards (extreme right) QRS axis, negative QRS in V6, and an apparently monophasic QRS in V1, as opposed to the rSR' pattern of right bundle branch block.&nbsp;</span><br style="font-size: 13.0080003738403px; line-height: 20.0063037872314px;" /><span style="font-size: 13.0080003738403px; line-height: 20.0063037872314px;">Remember, ALL wide-QRS tachycardias should be treated as V Tach until proven otherwise, as it is a life-threatening arrhythmia. &nbsp;Factors which lower cardiac output during V Tach include: &nbsp;Fast rate, wide QRS, and lack of P wave preceding the QRS. &nbsp;The sudden severe lowering of perfusion that usually accompanies V Tach can lead to rapid deterioraton and ventricular fibrillation.</span></p><p><span style="font-size: 13.0080003738403px; line-height: 20.0063037872314px;">For discussions by Jason Roediger (ECG GURU extroidonairre) on recognizing ventricular tachycardia, go to this <a title="Jason WCT" href="http://ecgguru.com/expert-review/question-does-extreme-right-axis-backward-always-indicate-ventricular-rhythm">LINK</a>, and this<a title="Jason on VT" href="http://ecgguru.com/expert-review/what-are-criteria-determining-wide-complex-tachycardia-v-tach"> LINK</a>.</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/23/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 Ventricular Tachycardia 1/5</option><option value="40">Give Ventricular Tachycardia 2/5</option><option value="60">Give Ventricular Tachycardia 3/5</option><option value="80">Give Ventricular Tachycardia 4/5</option><option value="100" selected="selected">Give Ventricular Tachycardia 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.8</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--5" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-xffOHyN-DpB1QZbh5ziU2sad3p3pKvp2ez6QZi4-KdI" /> <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/ventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ventricular tachycardia</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-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wide-complex 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_5"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fventricular-tachycardia-2&amp;title=Ventricular%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, 19 Mar 2015 20:42:08 +0000 Dawn 630 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ventricular-tachycardia-2#comments Anti-tachycardia Function of ICD https://www.ecgguru.com/ecg/anti-tachycardia-function-icd <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/anti-tachycardia-function-icd"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/PM%20200%20Antitachycardia%20functon%20of%20ICD%20from%20Brent%20DuBois.jpg" width="1200" height="474" 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 ECG was donated to the ECG Guru by Brent Dubois, and was originally published on the FaceBook page, Paramedic Tips &amp; Tricks. &nbsp;We published it to this site three years ago, but believe it should be shown again, as it is somewhat rare to catch a good-quality 12-Lead ECG of an implanted cardioverter-defibrillator pacemaer using overdrive pacing to terminate a ventricular tachycardia. &nbsp;Most of our examples have been rhythm strips.</p><p>In this strip, we see the patient in ventricular tachycardia (V tach) at a rate of about 190 / minute. &nbsp;The ICD, in response to the fast rate, delivers a short burst of even faster paced beats. &nbsp;The physological rule in the heart is, "the fastest pacemaker controls the heart". &nbsp;Once the pacemaker has terminated the V tach, it paces at a much slower rate. &nbsp;It is pacing the atria, and the conduction system is intact, allowing the impulse to travel normally through the ventricles. &nbsp;If the sinus node is able to "outpace" the slower paced rhythm, the heart will resume a sinus rhythm.</p><p>This is called "overdrive pacing" and is done automatically by an ICD that is programmed to do so. &nbsp;Overdrive pacing can also be accomplished by a temporary transvenous pacer or transcutaneous pacemaker. &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/23/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 Anti-tachycardia Function of ICD 1/5</option><option value="40">Give Anti-tachycardia Function of ICD 2/5</option><option value="60">Give Anti-tachycardia Function of ICD 3/5</option><option value="80">Give Anti-tachycardia Function of ICD 4/5</option><option value="100" selected="selected">Give Anti-tachycardia Function of ICD 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.1</span></span> <span class="total-votes">(<span >9</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-xpqJH2RA25ju0w7C8c8PByJBXYQld61rtLhwT6AlRK0" /> <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/icd" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ICD</a></div><div class="field-item odd"><a href="/ecg/pacemaker" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pacemaker</a></div><div class="field-item even"><a href="/ecg/anti-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Anti-tachycardia</a></div><div class="field-item odd"><a href="/ecg/overdrive-pacing" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Overdrive pacing</a></div><div class="field-item even"><a href="/ecg/ventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ventricular tachycardia</a></div><div class="field-item odd"><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 even"><a href="/ecg/tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">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_6"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fanti-tachycardia-function-icd&amp;title=Anti-tachycardia%20Function%20of%20ICD"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Tue, 06 Jan 2015 08:53:57 +0000 Dawn 613 at https://www.ecgguru.com https://www.ecgguru.com/ecg/anti-tachycardia-function-icd#comments Right Ventricular Outflow Tract Tachycardia (RVOT) https://www.ecgguru.com/ecg/right-ventricular-outflow-tract-tachycardia-rvot <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/right-ventricular-outflow-tract-tachycardia-rvot"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/WCT117%20Conv%20later%20with%20Amiodarone.jpg" width="1800" height="1038" 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 ECG was taken from a patient who was complaining of palpitations and tachycardia, but who was hemodynamically stable, with no history of heart disease. &nbsp;It is an example of RIGHT VENTRICULAR OUTFLOW TRACT TACHYCARDIA, a type of idiopathic ventricular tachycardia. &nbsp;The ECG signs of RVOT are: &nbsp;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.</p><p>RVOT accounts for about 10% of all ventricular tachycardias, and 70% of idiopathic VT. &nbsp;It is most often found in structurally normal hearts, but it may occur in patients with arrhythmogenic right ventricular dysplasia. &nbsp;For more on RVOT, read<a title="LITFL RVOT" href="http://lifeinthefastlane.com/ecg-library/rvo/"> Life In the Fast Lane</a>.</p><p>RVOT tachycardia sometimes <a title="Circulation Adenosine VT" href="http://circ.ahajournals.org/content/96/4/1192.full">converts with adenosine</a>. &nbsp;The patient in this example converted after being administered amiodarone.</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/23/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 Right Ventricular Outflow Tract Tachycardia (RVOT) 1/5</option><option value="40">Give Right Ventricular Outflow Tract Tachycardia (RVOT) 2/5</option><option value="60">Give Right Ventricular Outflow Tract Tachycardia (RVOT) 3/5</option><option value="80">Give Right Ventricular Outflow Tract Tachycardia (RVOT) 4/5</option><option value="100" selected="selected">Give Right Ventricular Outflow Tract Tachycardia (RVOT) 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.3</span></span> <span class="total-votes">(<span >3</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-eV5qsZdNfmfeIiZtVdZid2D0GeyD6KvLB9OfbDHh5UA" /> <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/ventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ventricular tachycardia</a></div><div class="field-item odd"><a href="/ecg/right-ventricular-outflow-tract-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Right ventricular outflow tract 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/idiopathic-ventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Idiopathic ventricular tachycardia</a></div><div class="field-item even"><a href="/ecg/tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">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_7"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fright-ventricular-outflow-tract-tachycardia-rvot&amp;title=Right%20Ventricular%20Outflow%20Tract%20Tachycardia%20%28RVOT%29"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Tue, 16 Dec 2014 06:00:41 +0000 Dawn 610 at https://www.ecgguru.com https://www.ecgguru.com/ecg/right-ventricular-outflow-tract-tachycardia-rvot#comments Supraventricular Tachycardia https://www.ecgguru.com/ecg/supraventricular-tachycardia-1 <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/supraventricular-tachycardia-1"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/SVT103.jpg" width="1800" height="1443" 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 ECG shows AV nodal reentrant tachycardia in an elderly man. &nbsp;Clinical information is not available. &nbsp;AVNRT is the rhythm most often associated with the term, "supraventricular tachycardia".</p><p>Although we can't see the beginning of this rhythm, one of the identifying features of SVT is an abrupt (paroxysmal) onset. &nbsp;In patients with AVNRT, there are two pathways in the AV node, a pathway with fast conduction and a long refractory period, and a pathway with slow conduction and a short refractory period. &nbsp;Normal sinus impulses travel down the fast pathway and into the ventricles, but also start up the slow pathway in a retrograde direction. The retrograde impulse and the normal impulse traveling down the slow pathway collide, cancelling each other out. &nbsp;If a PAC occurs, it will travel down the slow pathway while the fast pathway is still refractory. &nbsp;By the time the impulse reaches the end of the slow pathway, it finds the fast pathway no longer refractory, and travels back up to the atria. &nbsp;This forms a circular movement (circus movement) of the impulse, and it repeats itself rapidly until interrupted. &nbsp;When each impulse reaches the ventricles, it travels into the interventricular conduction system and causes ventricular depolarization and contraction, usually at a rate of 140 - 250+. &nbsp;Unlike sinus tachycardia, AVNRT does not adjust its rate according to the needs or activity of the patient.</p><p>There are many forms of supraventricular tachycardia, and they are not always easy to differentiate based on ECG criteria alone. &nbsp;AVNRT of the type described above is the most common PSVT in structurally normal hearts. &nbsp;For more information on supraventricular tachycardia, go to <a title="LITFL SVT" href="http://www.lifeinthefastlane.com/ecg-ecg-library/svt/">Life in the Fast Lane</a>. &nbsp;For a discussion on clinical management, we recommend&nbsp;Dr. Grauer's <a title="Dr. Grauer Video SVT" href="https://www.youtube.com/watch?v=K827SARyi04">ECG Video 6</a> - Rhythm Mgmt-Part 3.</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/23/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 Supraventricular Tachycardia 1/5</option><option value="40">Give Supraventricular Tachycardia 2/5</option><option value="60">Give Supraventricular Tachycardia 3/5</option><option value="80">Give Supraventricular Tachycardia 4/5</option><option value="100" selected="selected">Give Supraventricular Tachycardia 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 >2</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-ubfSxTs4qbEdqAAJKTkxAah7cZvUmCw6AXAJidkbkb0" /> <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/avnrt" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">AVNRT</a></div><div class="field-item odd"><a href="/ecg/paroxysmal-supraventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Paroxysmal supraventricular tachycardia</a></div><div class="field-item even"><a href="/ecg/tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Tachycardia</a></div><div class="field-item odd"><a href="/ecg/supraventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Supraventricular 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_8"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fsupraventricular-tachycardia-1&amp;title=Supraventricular%20Tachycardia"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Fri, 05 Dec 2014 05:47:54 +0000 Dawn 609 at https://www.ecgguru.com https://www.ecgguru.com/ecg/supraventricular-tachycardia-1#comments ECG Basics: Paroxysmal Supraventricular Tachycardia https://www.ecgguru.com/ecg/ecg-basics-paroxysmal-supraventricular-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/ecg-basics-paroxysmal-supraventricular-tachycardia"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/135%20NSR%20to%20SVT_0.jpg" width="1800" height="364" 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 two-lead rhythm strip clearly shows the transition from normal sinus rhythm to a paroxysmal supraventricular rhythm. &nbsp;In this case, the arrhythmia is AV nodal reentrant tachycardia, AVNRT. &nbsp;The rate of the first rhythm, NSR, is around 75 per minute. &nbsp;The fourth beat on the strip is a PAC which initiates the paroxysm of tachycardia lasting 12 beats. &nbsp;The arrhythmia terminates spontaneously at that point. &nbsp;The tachycardia rate is about 150/min.</p><p>The topic of supraventricular tachycardias can be a very complex one to teach. &nbsp;For an excellent example of a concise lesson geared toward Primary Practice physicians, go to Dr. Grauer's <a title="Grauer SVT Video" href="https://www.youtube.com/watch?v=K827SARyi04&amp;feature=youtu.be">VIDEO</a> - Part III of his Arrhythmia series.</p><p>To cover the important points for the beginner-level student:</p><p>&nbsp; * &nbsp;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. &nbsp;If the onset (or offset) is sudden, then this is not a sinus rhythm. &nbsp;The sinus node speeds and slows more gradually - it doesn't change rates in one heartbeat. &nbsp;This strip has an excellent view of BOTH the onset and the offset.</p><p>&nbsp; * &nbsp;The faster the rate, the more likely we are looking at a PSVT rather than sinus rhythm. &nbsp;If a sinus tachycardia exists, we can almost ALWAYS see the reason for it in the patient's clinical situation. &nbsp;We may see fever, dehydration, bleeding, fear, pain, exercise. &nbsp;Therefore, a patient at rest with a rate of 150 would be suspect for PSVT. &nbsp;A patient on a treadmill for 5 minutes would be considered to have a sinus rhythm.</p><p>&nbsp; * &nbsp;Any patient with a rate around 150 per minute should be evaluated for ATRIAL FLUTTER with 2:1 conduction. &nbsp;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. &nbsp;A 12-lead ECG makes it easier to search for tell-tale flutter waves.</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/23/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 ECG Basics: Paroxysmal Supraventricular Tachycardia 1/5</option><option value="40">Give ECG Basics: Paroxysmal Supraventricular Tachycardia 2/5</option><option value="60">Give ECG Basics: Paroxysmal Supraventricular Tachycardia 3/5</option><option value="80" selected="selected">Give ECG Basics: Paroxysmal Supraventricular Tachycardia 4/5</option><option value="100">Give ECG Basics: Paroxysmal Supraventricular Tachycardia 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.9</span></span> <span class="total-votes">(<span >7</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-Yu08FpWn55JMTbgYbb4Jp2UjBT2Zt9tOCvjOj9-FDqc" /> <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/ecg-basics" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ECG Basics</a></div><div class="field-item odd"><a href="/ecg/basic-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Basic ECG</a></div><div class="field-item even"><a href="/ecg/paroxysmal-supraventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Paroxysmal supraventricular tachycardia</a></div><div class="field-item odd"><a href="/ecg/avnrt" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">AVNRT</a></div><div class="field-item even"><a href="/ecg/rhythm-strip" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Rhythm strip</a></div><div class="field-item odd"><a href="/ecg/supraventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Supraventricular tachycardia</a></div><div class="field-item even"><a href="/ecg/tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">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_9"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fecg-basics-paroxysmal-supraventricular-tachycardia&amp;title=ECG%20Basics%3A%20%20Paroxysmal%20Supraventricular%20Tachycardia"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sat, 22 Nov 2014 03:07:55 +0000 Dawn 607 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-paroxysmal-supraventricular-tachycardia#comments Atrial Flutter With Variable Conduction https://www.ecgguru.com/ecg/atrial-flutter-variable-conduction-1 <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-flutter-variable-conduction-1"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AFL%20100%20Atrial%20flutter%20w%20variable%20cond.jpg" width="1800" height="1485" alt="" /></a></div><div class="field-item odd"><a href="/ecg/atrial-flutter-variable-conduction-1"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AFL%20100%20Atrial%20flutter%20w%20variable%20cond%20beats%20numbered.jpg" width="1800" height="1485" 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 ECG provides an example of atrial flutter with variable conduction. &nbsp;There are two distinct R - R intervals, making this a somewhat <strong>regularly-irregular</strong> &nbsp;rhythm, as opposed to the irregular irregularity of atrial fibrillation. &nbsp;The flutter waves (P waves) are very easy to see in most leads, but not in all. &nbsp;If you are teaching students who are making the transition from reading monitors and rhythm strips to 12-lead ECGs, this is a great ECG to illustrate for them how the more leads you have, the more you will see. &nbsp;The flutter waves are invisible in Lead I and, to the untrained eye, they may be hard to see in the precordial leads. &nbsp;The four channels on this ECG are run simultaneously, so if &nbsp;P waves or flutter waves are visible in one lead, they are also present in all leads that line up vertically with that one. &nbsp;In other words, the Lead II rhythm strip at the bottom confirms that flutter waves exist across the entire ECG.</p><p>The R - R intervals in this ECG reflect alternating 2:1 and 4:1 conduction. &nbsp;There are a couple of times when the 4:1 ratio repeats itself without alternating. &nbsp;Often, the length of these varying R - R intervals will be multiples of each other, or have a common denominator. &nbsp;These do not appear to, and may reflect the fact that, when R to P intervals lengthen, R to R intervals sometimes shorten. &nbsp;In other words, the PR intervals, which are difficult to measure in atrial flutter, may be changing. &nbsp;I would invite my colleagues with more expertise in this area to comment below.</p><p>There are no blatant ST segment abnormalities here, but ST segments can be very difficult to assess in atrial flutter because of the flutter waves. &nbsp;We do not have clinical data, other than this is a 62-year-old man.</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/23/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 Atrial Flutter With Variable Conduction 1/5</option><option value="40">Give Atrial Flutter With Variable Conduction 2/5</option><option value="60">Give Atrial Flutter With Variable Conduction 3/5</option><option value="80" selected="selected">Give Atrial Flutter With Variable Conduction 4/5</option><option value="100">Give Atrial Flutter With Variable Conduction 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.4</span></span> <span class="total-votes">(<span >52</span> votes)</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-HAE1gHcHt9V8AmEAKjAJh50qqtsHB036I5xkUZ9WO3E" /> <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/tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Tachycardia</a></div><div class="field-item even"><a href="/ecg/wenckebach-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wenckebach Conduction</a></div><div class="field-item odd"><a href="/ecg/grouped-beating" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Grouped beating</a></div><div class="field-item even"><a href="/ecg/atrial-flutter-ariable-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial flutter with ariable 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_10"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fatrial-flutter-variable-conduction-1&amp;title=Atrial%20Flutter%20With%20Variable%20Conduction"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Tue, 04 Nov 2014 06:24:57 +0000 Dawn 604 at https://www.ecgguru.com https://www.ecgguru.com/ecg/atrial-flutter-variable-conduction-1#comments