ECG Guru - Instructor Resources - Concealed conduction https://www.ecgguru.com/ecg/concealed-conduction en AV Block With Changing PR Intervals https://www.ecgguru.com/ecg/av-block-changing-pr-intervals <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/av-block-changing-pr-intervals"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Type%20II%20second%20deg%20with%20dual%20AV%20pathways.jpg" width="1800" height="708" 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"><span style="font-size: 12.0pt; line-height: 107%;">Just like other subjects we are taught in school, ECG interpretation is usually taught in a very basic, simplistic way.&nbsp; As we add to our knowledge, we are able to determine the mechanisms of more complex rhythms.</span><span style="font-size: 12pt;">&nbsp;</span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">When I took my first basic ECG rhythm monitoring course, I memorized all the “rules”, and at the end of the course, I thought I could read ANY strip correctly.&nbsp; Then, in real life, I found that some rhythms can’t be interpreted from one lead, or even from one 12-lead ECG.</span><span style="font-size: 12pt;">&nbsp;</span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">This strip offers advanced readers to challenge themselves, and it offers teachers a chance to show students an “exception to the rules” if it is appropriate for those students.&nbsp; We all learn the classification of second-degree AV blocks:&nbsp; Both Type I and Type II show an underlying sinus rhythm with some P waves conducted and some not.&nbsp; Type I has progressively prolonging PR intervals until a P wave is non-conducted.&nbsp; The cycle restarts after the dropped QRS.&nbsp; Type II has PR intervals that are all the same, and may be prolonged or normal.</span><span style="font-size: 12pt;">&nbsp;</span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">In this ECG, you will be able to “march out” a normal sinus rhythm at a rate of 80 bpm.&nbsp; The P waves are marked with small dots at the bottom.&nbsp; Two of every three P waves are followed by QRS complexes.&nbsp; Is it Type I?&nbsp; No – the PR intervals are not prolonging.&nbsp; Is it Type II?&nbsp; The PR intervals are not the same!&nbsp; What is happening?</span><span style="font-size: 12pt;">&nbsp;</span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">There is also left bundle branch block, which is a sub-Hisian block.&nbsp; Blocks occurring in the intraventricular conduction system include bundle branch blocks, second-degree AVB Type II,&nbsp; and third-degree AVB with ventricular escape.&nbsp; This group of blocks tends to be more threatening than the blocks that occur in the AV node (second-degree type I and third-degree with junctional escape).</span><span style="font-size: 12pt;">&nbsp;</span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">In this strip, you will notice that the first conducted P wave in each group conducts with a PRI of about .34 seconds (340 ms).&nbsp; The second PRI in each group conducts with a PRI of about .24 seconds (240 ms).&nbsp; They are decreasing before the non-conducted beat.&nbsp; There are several possible explanations for the change in PRI.&nbsp; One is </span><a href="http://content.onlinejacc.org/article.aspx?articleid=1121671"><span style="font-size: 12.0pt; line-height: 107%;">PRI alternans</span></a><span style="font-size: 12.0pt; line-height: 107%;">, due to conduction alternating through two AV pathways, one fast, one slow.&nbsp; Another is </span><a href="https://www.ncbi.nlm.nih.gov/m/pubmed/8269303/"><span style="font-size: 12.0pt; line-height: 107%;">supernormal conduction</span></a><span style="font-size: 12.0pt; line-height: 107%;">.</span><span style="font-size: 12pt;">&nbsp;</span></p><p>&nbsp;</p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">We would be very interested to hear what our readers think of this interesting ECG. For beginner students – don’t be scared off by complex mechanisms.&nbsp; To the patient, the bottom line is RATE.&nbsp; Initial treatment should be aimed at maintaining a workable rate and adequate perfusion.&nbsp; The actual mechanism of the dysrhythmia may need to be determined later by experts, and it may require evaluation in the electrophysiology lab for a firm diagnosis.&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/381/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 AV Block With Changing PR Intervals 1/5</option><option value="40">Give AV Block With Changing PR Intervals 2/5</option><option value="60">Give AV Block With Changing PR Intervals 3/5</option><option value="80" selected="selected">Give AV Block With Changing PR Intervals 4/5</option><option value="100">Give AV Block With Changing PR Intervals 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 >9</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-SbNVrp7Yc8iJqrHWsZZouIWteHskanqD6RMSgeOGLE0" /> <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/second-degree-av-block-type-ii" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Second-degree AV block Type II</a></div><div class="field-item odd"><a href="/ecg/pr-alternans" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">PR alternans</a></div><div class="field-item even"><a href="/ecg/concealed-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Concealed conduction</a></div><div class="field-item odd"><a href="/ecg/dual-av-conduction-pathways" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Dual AV conduction pathways</a></div><div class="field-item even"><a href="/ecg/av-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">AV Block</a></div><div class="field-item odd"><a href="/ecg/supernormal-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Supernormal conduction</a></div><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></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%2Fav-block-changing-pr-intervals&amp;title=%20AV%20Block%20With%20Changing%20PR%20Intervals"><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, 29 Sep 2016 03:23:59 +0000 Dawn 711 at https://www.ecgguru.com https://www.ecgguru.com/ecg/av-block-changing-pr-intervals#comments Jason's Blog: ECG Challenge of the month of November, 2013. https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-month-november-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-november-2013"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Month%202s%20ladder1.png" width="788" height="509" 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>Sticking with the same general theme from my last <a href="http://ecgguru.com/ecg/atrial-flutter-31-v-conduction" target="_blank">ECG Challenge for the months of September and October, 2013</a>.&nbsp; This is more of a back-to-basics for some readers but will still challenge others.&nbsp; No information for this patient other than it was an adult.&nbsp; How would you interpret this? &nbsp;&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/381/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 Jason&amp;#039;s Blog: ECG Challenge of the month of November, 2013. 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge of the month of November, 2013. 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge of the month of November, 2013. 3/5</option><option value="80">Give Jason&amp;#039;s Blog: ECG Challenge of the month of November, 2013. 4/5</option><option value="100" selected="selected">Give Jason&amp;#039;s Blog: ECG Challenge of the month of November, 2013. 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 >10</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-dYOYtPb1aHcOnx4sVPSnbtOYpNdVCCXNZDMC27eKzGU" /> <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_2"> <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-november-2013&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20of%20the%20month%20of%20November%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> Sun, 17 Nov 2013 15:43:23 +0000 jer5150 518 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-month-november-2013#comments Jason's Blog: ECG Challenge for the months of September and October, 2013. https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-months-september-and-october-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-months-september-and-october-2013"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Month%202r%20ladder1.png" width="787" height="567" 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><span style="text-decoration: underline;"><strong>Patient's clinical data:&nbsp;</strong></span> 56-year old man. <br><br>At Dawn's request, this month's ECG is laying down the foundation for a topic she wanted me to eventually talk about on the ECG Guru.&nbsp; On this ECG, I'm not just looking for the obvious disturbance of rhythm.&nbsp; This type of ECG is literally begging for a laddergram to help reveal the mechanism responsible for a couple of very subtle and rare findings. <br><br>Discovering the <em>full</em> interpretation will take careful observations and measurements with calipers.<br><br>This ECG would definitely qualify as an "advanced".&nbsp; How do I know this?&nbsp; The only book I've ever seen an example of this mechanism was in Pick &amp; Langendorf's book titled Interpretation of Complex Arrhythmias. <br><br>Have fun deciphering the 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/381/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 Jason&amp;#039;s Blog: ECG Challenge for the months of September and October, 2013. 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge for the months of September and October, 2013. 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge for the months of September and October, 2013. 3/5</option><option value="80">Give Jason&amp;#039;s Blog: ECG Challenge for the months of September and October, 2013. 4/5</option><option value="100" selected="selected">Give Jason&amp;#039;s Blog: ECG Challenge for the months of September and October, 2013. 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--3" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-VmS4SqYXDuNlzmlNnHxKVThQVvFuTrHZwCk4e-oNj2M" /> <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_3"> <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-months-september-and-october-2013&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20for%20the%20months%20of%20September%20and%20October%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> Sat, 14 Sep 2013 13:26:12 +0000 jer5150 493 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-months-september-and-october-2013#comments