ECG Guru - Instructor Resources

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Dawn's picture

Instructors' Collection ECG: Left Bundle Branch Block

Thu, 08/12/2021 - 15:08 -- Dawn

This ECG is taken from an elderly man with heart failure. 

The ECG   The first feature that might capture your attention is the wider-than-normal QRS complex, which is 160 ms (.16 seconds).  The rate is 58 bpm. We do not know the patient’s medications or baseline rate.  There are P waves present, and so the rhythm is SINUS BRADYCARDIA. The P waves are broad , > 110 ms in Lead II (red lines in close up) and bifid, with greater than 40 ms between the two peaks in Lead II (blue lines).  In V1, the P waves are biphasic, with the terminal negative portion greater than 40 ms duration (red lines). This meets the ECG criteria for LEFT ATRIAL ENLARGEMENT, or preferably, LEFT ATRIAL ABNORMALITY. (https://LITFL.com/left-atrial-enlargement-ecg-library/) ECG criteria are not highly accurate for detecting atrial enlargement, and abnormal findings should be confirmed by anatomic measurement. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2244611/).

The QRS complexes, as mentioned, are wide. Because there is sinus rhythm, we know the delay in conduction is due to interventricular conduction delay, and not to ventricular rhythm.  This ECG meets the criteria for LEFT BUNDLE BRANCH BLOCK. 

·        Supraventricular rhythm 

·        Wide QRS (>.12 seconds)

Dawn's picture

Ask The Expert

Sun, 12/20/2020 - 12:02 -- Dawn

Today's Expert is Dr. Jerry Jones, MD, FACEP, FAAEM                                                                                                                                                             

 Jerry W. Jones, MD FACEP FAAEM is a diplomate of the American Board of Emergency Medicine who has practiced internal medicine and emergency medicine for 35 years.    

Dr. Jones has been on the teaching faculties of the University of Oklahoma and The University of Texas Medical Branch in Galveston. He is a published author who has also been featured in the New York Times and the Annals of Emergency Medicine for his work in the developing field of telemedicine. He is also a Fellow of the American College of Emergency Physicians and a Fellow of the American Academy of Emergency Medicine and, in addition, a member of the European Society of Emergency Medicine. 

 Dr. Jones is the CEO of Medicus of Houston and the principal instructor for the Advanced ECG Interpretation Boot Camp and the Advanced Dysrhythmia Boot Camp.                                                                                                                                                                                                                                                                                                                    

 

Question:  I teach beginner students. How can I explain the complex subject of “AV Blocks”?  I don’t want to teach incorrect information while trying to simplify the subject.

 

 Answer:  AV Blocks Article By Dr. Jerry Jones  (click link)


Dawn's picture

ECG Basics: Second-degree AV Block, Type II

Tue, 12/08/2020 - 15:31 -- Dawn

This rhythm strip was obtained from a man who was suffering an acute inferior wall M.I.  There are ST elevation and hyperacute T waves.  The rhythm is SINUS ARRHYTHMIA WITH SECOND-DEGREE AV BLOCK, TYPE II.    There is also first-degree AV block.

There are more P waves than QRS complexes, with a 3:2 ratio.  The atrial rate varies between 55 -68 beats per minute.  The sinus rate speeds slightly after the dropped QRS in each group. The ventricular rate is about 40 bpm, with grouped beating. (Regularly irregular.)

The PR intervals are steady at 226 ms (slightly prolonged).

Dawn's picture

ECG Glossary from Dr. Ken Grauer

Sat, 06/08/2019 - 14:16 -- Dawn

Are you looking for a comprehensive ECG glossary that goes beyond simply defining words? Dr. Ken Grauer, who is the ECG Guru's Consulting Expert, has a Glossary available on his website that explains the terms.  Instructors and students alike will benefit from having this glossary readily available.  The glossary is exerpted from his e-Publication, "A 1st Book On ECGs - 2014", available on Amazon.

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1924:  Willem Einthoven wins the Nobel prize for inventing the electrocardiograph.

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