ECG Guru - Instructor Resources

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Instructors' Collection ECG: Rate-related Left Bundle Branch Block

Fri, 01/14/2022 - 16:58 -- Dawn

The patient:  This ECG is from an 87-year-old man who was transported to the Emergency Department by paramedics. His chief complaint, as reported by caregivers, was lethargy, fever, and a declining mental status.  He appeared tired and slightly confused, and was normotensive.

The ECG:  There are a rhythm strip with two leads, II and III, and also a standard 12-lead ECG. The RHYTHM STRIP shows a tachycardiac rhythm that slows very slightly toward the end.  The rate is around 107 bpm, with an R to R interval of approximately 543 ms in the earlier, regular portion.  There are regular P waves present, all followed by QRS complexes.  Most of the QRS complexes are normal width, but the 2nd, 5th, and 8th are slightly wide at 130 ms, or .13 seconds.

These wider QRS complexes represent aberrant conduction with LBBB occurring intermittently.  Aberrant conduction often occurs due to a faster heart rate, but the only clue here is the intermittent conduction disturbance seems to disappear when the rate slows very slightly.  It is hard to determine mechanism of aberrant conduction when we have only a ten-second rhythm strip.

The 12-LEAD ECG  has essentially the same rate and rhythm, except all the beats in the first ¾ of the ECG are conducted aberrantly, in a LEFT BUNDLE BRANCH BLOCK pattern.  This indicates that the LBB is refractory at this time.  Beat No. 15 is premature (PAC).  The pause after the PAC allows the left bundle branch to repolarize, conducting one single beat normally.

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ECG Basics: Paroxysmal Supraventricular Tachycardia Converting to Sinus With PACs

Fri, 10/29/2021 - 15:20 -- Dawn

This strip shows a supraventricular tachycardia, rate 196 bpm, after adenosine was administered to the patient.  The PSVT breaks, and an irregular rhythm composed of sinus beats and premature atrial contractions ensues.  This is common after medical cardioversion. The patient later settled into a normal sinus rhythm.  The abrupt change from a fast, regular rhythm to a slower, irregular rhythm is evidence that the tachycardia was due to a reentrant circuit, and not sinus tachycardia.

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Ask The Expert

Fri, 10/01/2021 - 14:38 -- Dawn

Dr. Jerry W. Jones, MD, FACEP, FAAEM has graciously shared with us his four-part article on the topic of “Delays & Blocks Involving the Bundle Branches”.

Dr. Jones is a talented instructor who makes difficult topics easy.  Please feel free to post your comments and questions for Dr. Jones and our other ECG Gurus. 

Click THIS LINK for a downloadable pdf of Part 1: Non-Specific Intraventricular Conduction Delays. 

Click THIS LINK for a downloadable pdf of Part 2: Left Bundle Branch Block.

Click THIS LINK for a downloadable pdf of Part 3: Right Bundle Branch Block.

Click THIS LINK for a downloadable pdf of Part 4: The Fascicles of the Left Bundle Branch 

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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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