ECG Guru - Instructor Resources - VPB https://www.ecgguru.com/ecg/vpb en 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/65/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 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" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-y6Hg2rXw-W4cq3lRthyMwBMw6lsNGx7GSQqV_aPkk6o" /> <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_1"> <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> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></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 of the Week for March 10th - 17th. Mutual mimics https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-march-10th-17th-mutual-mimics <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-week-march-10th-17th-mutual-mimics"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%202i-a%20ladder.png" width="765" height="599" alt="" /></a></div><div class="field-item odd"><a href="/blog/jasons-blog-ecg-challenge-week-march-10th-17th-mutual-mimics"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%202i-b%20ladder.png" width="765" height="566" 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>These are two 12-lead ECGs that I performed on two <em>completely different</em> patients several years apart.&nbsp; <br><br><span style="text-decoration: underline;"><strong>Patient's clinical data</strong></span> (Top ECG): <br>57-year-old black man <br><br><strong><span style="text-decoration: underline;">Patient's clinical data</span></strong> (Bottom ECG):<br>67-year-old black man<br><br>Are both of these ECGs showing the same rhythmic pattern?</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/65/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 Week for March 10th - 17th. Mutual mimics 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for March 10th - 17th. Mutual mimics 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for March 10th - 17th. Mutual mimics 3/5</option><option value="80" selected="selected">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for March 10th - 17th. Mutual mimics 4/5</option><option value="100">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for March 10th - 17th. Mutual mimics 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--2" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-LyX361HpSqpmz4jdQhGIiXYKf4SNx-CpYMsxbvKeZIM" /> <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-week-march-10th-17th-mutual-mimics&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20of%20the%20Week%20for%20March%2010th%20-%2017th.%20%20Mutual%20mimics"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sat, 09 Mar 2013 16:31:51 +0000 jer5150 412 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-march-10th-17th-mutual-mimics#comments Jason's Blog: ECG Challenge of the Week for Dec. 23rd - 30th. https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-dec-23rd-30th <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-week-dec-23rd-30th"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201y%20answer.png" width="765" height="532" alt="" /></a></div><div class="field-item odd"><a href="/blog/jasons-blog-ecg-challenge-week-dec-23rd-30th"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201y%20supplimental.png" width="765" height="76" alt="" /></a></div><div class="field-item even"><a href="/blog/jasons-blog-ecg-challenge-week-dec-23rd-30th"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Rabbit%20ear.png" width="1270" height="730" 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>I performed this ECG earlier this year in an outpatient clinic. <br><br><span style="text-decoration: underline;"><strong>Patient's clinical data:</strong></span>&nbsp; 85-year-old white man; asymptomatic.&nbsp; <br><br><strong><span style="text-decoration: underline;">Questions?</span></strong><br>(1.)&nbsp; What rhythm is this tracing showing?<br>(2.)&nbsp; What clue/sign is used to differentiate between the two anomalous beats (i.e., 4th and 6th beats).&nbsp; HINT:&nbsp; It's named after a part of a certain animal's anatomy.<br><br>** *** NOTE *** **:&nbsp; For the sake of determining QRS morphology and axis, I've also included a simultaneous single-channel rhythm strip of Lead I directly below the 12-lead ECG.&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/65/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 of the Week for Dec. 23rd - 30th. 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Dec. 23rd - 30th. 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Dec. 23rd - 30th. 3/5</option><option value="80" selected="selected">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Dec. 23rd - 30th. 4/5</option><option value="100">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Dec. 23rd - 30th. 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 >168</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-bibygutZCp7cTxPwi8mHG8ADaJUfsNqSU3iTfhX6JX4" /> <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-week-dec-23rd-30th&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20of%20the%20Week%20for%20Dec.%2023rd%20-%2030th."><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 Dec 2012 20:08:27 +0000 jer5150 384 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-dec-23rd-30th#comments Jason's Blog: ECG Challenge of the Week for Nov. 4th - 18th. https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-nov-4th-18th <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-week-nov-4th-18th"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201t%20ladder.png" width="765" height="499" alt="" /></a></div><div class="field-item odd"><a href="/blog/jasons-blog-ecg-challenge-week-nov-4th-18th"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201t%20clue.png" width="769" height="668" 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 class="userContent">This is a "Routine" resting 12-lead ECG I performed on a patient several months ago in the Outpatient ECG Lab.<br> <br> <span style="text-decoration: underline;"><strong>PATIENT CLINICAL DATA:</strong></span><br> 72-year-old white man; asymptomatic; resting comfortably in recumbent position.<br><br></span><span class="userContent">This is an exercise in "anomalous" beats. <br> <br> <span style="text-decoration: underline;"><strong>QUESTION:</strong></span><br>(1.)&nbsp; Specifically, what are 3rd, 4th, and 10th beats?<br><br>You may wish to review another ECG that I performed I few years ago:&nbsp; <a href="http://www.ekgguru.com/content/sr-ectopy-pac-non-cond-pac-pvc-ventricular-escape-laddergram" target="_blank">http://www.ekgguru.com/content/sr-ectopy-pac-non-cond-pac-pvc-ventricular-escape-laddergram </a><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/65/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 Jason&amp;#039;s Blog: ECG Challenge of the Week for Nov. 4th - 18th. 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Nov. 4th - 18th. 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Nov. 4th - 18th. 3/5</option><option value="80">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Nov. 4th - 18th. 4/5</option><option value="100" selected="selected">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Nov. 4th - 18th. 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >5</span></span> <span class="total-votes">(<span >1</span> vote)</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-ReF4dfyKuBWvRRQQ_bI7xY7zngD0DhcAejceHkppL4U" /> <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_4"> <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-week-nov-4th-18th&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20of%20the%20Week%20for%20Nov.%204th%20-%2018th."><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 04 Nov 2012 00:46:41 +0000 jer5150 359 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-nov-4th-18th#comments Jason’s blog: ECG Challenge of the Week for July 29th – August 5th. What's causing this rare combination? https://www.ecgguru.com/blog/jason%E2%80%99s-blog-ecg-challenge-week-july-29th-%E2%80%93-august-5th-whats-causing-rare-combination <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/jason%E2%80%99s-blog-ecg-challenge-week-july-29th-%E2%80%93-august-5th-whats-causing-rare-combination"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201f.png" width="765" height="862" 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>I performed this 12-lead ECG (Fig. 1) several years ago in the medical intensive care unit (MICU) while standing at the patient's bedside.&nbsp; As I was recording the ECG, I distinctly remember thinking to myself:&nbsp; <em>"this patient looks REALLY sick!"</em> for being as relatively young as he was.&nbsp; Immediately after I printed out the hardcopy, I reviewed the computer's interpretive statements at the top of the page.&nbsp; The computer listed an uncommon pair of findings which I confirmed to be true.&nbsp; I asked the assigned nurse if her patient had the clinical condition that this combination is <em>highly suggestive</em> of.&nbsp; She shrugged her shoulders at me and said she didn't know.&nbsp; I consulted the patient's computerized record and right there listed at the top of their "active problems" was the very condition I suspected the patient of having.&nbsp; <br /><span style="text-decoration: underline;"><strong><br />Patient's clinical data:</strong></span>&nbsp; 49-year-old black man with history of Type II diabetes mellitus (DM) and <em>this other clinical condition.&nbsp; </em></p> <p><span style="text-decoration: underline;"><strong>Fig. 1:</strong></span>&nbsp; I performed this ECG exactly 5 months and 5 days <em>before</em> the ECG in Fig. 2.</p> <p><span style="text-decoration: underline;"><strong>Fig. 2:</strong></span>&nbsp; This ECG was performed on a outpatient basis during a follow-up appointment with their physician.&nbsp; Have things improved or have they gotten worse? </p> <p><span style="text-decoration: underline;"><strong>QUESTIONS:</strong></span>&nbsp; In fig. 1, what rare combination of findings are present and what are those two findings <em>highly suggestive</em> of?&nbsp; What would explain the dramatic changes seen in Fig. 2? &nbsp; </p> <p><span style="text-decoration: underline;"><strong>HINT:</strong></span>&nbsp; Figures 1 and 2 both look dissimilar enough (esp. given the sequence in which they were recorded) that one might suspect they're from two completely different patients and technically that assumption would not be entirely wrong.&nbsp; Of what am I hinting towards?&nbsp; To be clear, both of these ECGs were performed on the same 49-year-old black male patient. &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/65/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 Jason’s blog: ECG Challenge of the Week for July 29th – August 5th. What&amp;#039;s causing this rare combination? 1/5</option><option value="40">Give Jason’s blog: ECG Challenge of the Week for July 29th – August 5th. What&amp;#039;s causing this rare combination? 2/5</option><option value="60">Give Jason’s blog: ECG Challenge of the Week for July 29th – August 5th. What&amp;#039;s causing this rare combination? 3/5</option><option value="80">Give Jason’s blog: ECG Challenge of the Week for July 29th – August 5th. What&amp;#039;s causing this rare combination? 4/5</option><option value="100" selected="selected">Give Jason’s blog: ECG Challenge of the Week for July 29th – August 5th. What&amp;#039;s causing this rare combination? 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >5</span></span> <span class="total-votes">(<span >1</span> vote)</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-9Vt2Dv0dl9Wvt4iRqR8zM9s2_HeTKBWvbeVLNU7x3B0" /> <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_5"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fblog%2Fjason%25E2%2580%2599s-blog-ecg-challenge-week-july-29th-%25E2%2580%2593-august-5th-whats-causing-rare-combination&amp;title=Jason%E2%80%99s%20blog%3A%20ECG%20Challenge%20of%20the%20Week%20for%20July%2029th%20%E2%80%93%20August%205th.%20What%27s%20causing%20this%20rare%20combination%3F"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 29 Jul 2012 07:23:30 +0000 jer5150 256 at https://www.ecgguru.com https://www.ecgguru.com/blog/jason%E2%80%99s-blog-ecg-challenge-week-july-29th-%E2%80%93-august-5th-whats-causing-rare-combination#comments Jason's Blog: ECG Challenge of the Week for July 1-8. What mechanism of conduction is responsible for the alternating P-R intervals? https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-july-1-8-what-mechanism-conduction-responsible-alternating-p-r <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-week-july-1-8-what-mechanism-conduction-responsible-alternating-p-r"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/1%20of%202%20with%20ladder.png" width="776" height="627" alt="" /></a></div><div class="field-item odd"><a href="/blog/jasons-blog-ecg-challenge-week-july-1-8-what-mechanism-conduction-responsible-alternating-p-r"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/2%20of%202%20with%20ladder.png" width="787" height="605" 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="font-size: medium; font-family: times new roman,times;"><br><br></span></p> <ul> <li><span style="font-size: medium; font-family: times new roman,times;">Sometimes less is more!&nbsp; I've overhauled this blog by streamlining it's content and creating a shorter version.&nbsp; We'd love to hear your feedback. &nbsp;&nbsp; </span></li> </ul> <p><span style="font-size: medium; font-family: times new roman,times;">This week's entry is courtesy of guest contributor, fellow blogger, and ECG Guru member <a href="http://www.ekgguru.com/users/drarnel" target="_blank">DrArnel</a>.&nbsp; My first direct contact with <a href="http://www.blogger.com/profile/05756963098199079474" target="_blank">Dr. Arnel Carmona</a> was back on May 28th of this year.&nbsp; At the encouragement of <a href="https://www.kg-ekgpress.com/" target="_blank">Dr. Ken Grauer</a>, I decided to email Arnel with the intent of expressing my alternate interpretations of the rhythms seen above.&nbsp; In his reply to me, Arnel was very receptive and has even gone on to share these tracings with <a href="http://www.med.umn.edu/cardiology/faculty/wang/home.html" target="_blank">Dr. Kyunhyun Wang</a>.&nbsp; I've taken the liberty of editing and paraphrasing Arnel's original comments in an attempt to summarize this case study without divulging the answer.&nbsp; In the interest of obtaining a "gold-standard" diagnosis, it should be noted that Arnel had these tracings professionally vetted by a cardiologist who specializes in cardiac electrophysiology (EP).&nbsp; These represent arrhythmias seen in the context of a background of drug use. <span style="text-decoration: underline;"><br></span><span style="text-decoration: underline;"><br></span><strong><span style="text-decoration: underline;">Patient’s clinical data:</span></strong>&nbsp; 50-year-old man who came in with dizziness/ (? syncope) with high BP, diaphoretic and irregular heart rate. Heart rate started in the upper 50's to upper 60's. Then at the strike of 1200 midnight these rhythms appeared.</span><br><br><span style="font-size: medium; font-family: times new roman,times;">The bedside nurse was so concerned because the patient was so diaphoretic. <br>Later this rhythm appeared in tracing <a href="http://www.ekgguru.com/sites/default/files/styles/scale_650px_width/public/1%20of%202%20with%20ladder.png" target="_blank">1 of 2</a>. <br><br></span><span style="font-size: medium; font-family: times new roman,times;">The on-call MD was called.&nbsp; At this point the bedside nurse called for a rapid response consult.</span><span style="font-family: times new roman,times;"><span style="font-size: medium;"><br><br></span></span><span style="font-family: times new roman,times;"><span style="font-size: medium;">Then later: <a href="http://www.ekgguru.com/sites/default/files/styles/scale_650px_width/public/2%20of%202%20with%20ladder.png" target="_blank">2 of 2</a></span><span style="font-size: medium;">.</span></span><br><br><span style="font-size: medium; font-family: times new roman,times;">So the critical care MD came and patient was started on isoproterenol drip. The other labs came and drug screen came with positive for amphetamines and cannabis. Amphetamine can explain the hypertension and diaphoresis.<br><br></span><span style="font-family: times new roman,times;"><span style="text-decoration: underline;"><strong><span style="font-size: medium;">Update-</span></strong></span><span style="font-size: medium;"><br></span></span><span style="font-size: medium; font-family: times new roman,times;">The isoproterenol did well. &nbsp;The next day the drip was tapered but the rhythm changed recurred. Also it was found out that the patient had a big cerebellar infarct producing the syndrome pseudotumoral cerebellar infarction.</span><br><br><span style="font-size: medium; font-family: times new roman,times;">On day 1 the patient was transferred to ICU and intubated due to the neuro condition. The rhythm problems did not recur.</span><br><br></p> <ul> <li class="MsoNormal" style="color: red; line-height: normal;"><strong><em><span style="text-decoration: underline;"><span style="font-size: 13.5pt; font-family: 'Times New Roman','serif';">Question:</span></span></em></strong><em><span style="font-size: 13.5pt; font-family: 'Times New Roman','serif';">&nbsp; What mechanism of conduction is this illustrating?</span></em></li> </ul> <p><br><span style="font-size: medium; font-family: times new roman,times;"><span style="text-decoration: underline;"><strong>Hint # 1:</strong></span>&nbsp; I've constructed "simplified" laddergrams directly underneath both of the rhythm tracings.&nbsp; </span><span style="font-size: 12pt; line-height: 115%; font-family: 'Times New Roman','serif';">In the A-V tier, note the two different styles of oblique lines.<span>&nbsp; </span>There are solid lines (i.e., <strong>–––––––––</strong> ) and there are broken/dashed lines (i.e., <strong>- - - - - - - -</strong> ).&nbsp; <br><br></span><span style="font-size: medium; font-family: times new roman,times;"><span style="text-decoration: underline;"><strong>Hint # 2:</strong></span>&nbsp; In tracing <a href="http://www.ekgguru.com/sites/default/files/styles/scale_650px_width/public/1%20of%202%20with%20ladder.png" target="_blank">1 of 2</a>, the 3rd and 13th beats are unifocal ventricular premature beats (VPBs).&nbsp; The first VPB is interpolated and interrupts an otherwise regular rhythm and triggers a prolongation of the P-R interval. A few seconds later the second VPB reverts the P-R interval back to its normal baseline appearance.&nbsp; In tracing <a href="http://www.ekgguru.com/sites/default/files/styles/scale_650px_width/public/2%20of%202%20with%20ladder.png" target="_blank">2 of 2</a>, the spontaneous prolongation of the P-R interval is not triggered by a VPB.&nbsp; Both of these tracings look nearly identical to ones I've seen both personally in my clinical career as well as tracings I've seen in publications by <a href="http://ac.els-cdn.com/S0735109797000119/1-s2.0-S0735109797000119-main.pdf?_tid=bf0ded189781f2a6a4089aadaa719887&amp;acdnat=1341369596_070a7e4aa9df6be4c04692cbe2d7be1d" target="_blank">Dr. Charles Fisch</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/65/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 Jason&amp;#039;s Blog: ECG Challenge of the Week for July 1-8. What mechanism of conduction is responsible for the alternating P-R intervals? 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for July 1-8. What mechanism of conduction is responsible for the alternating P-R intervals? 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for July 1-8. What mechanism of conduction is responsible for the alternating P-R intervals? 3/5</option><option value="80">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for July 1-8. What mechanism of conduction is responsible for the alternating P-R intervals? 4/5</option><option value="100">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for July 1-8. What mechanism of conduction is responsible for the alternating P-R intervals? 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="empty">No votes yet</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--6" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form--VldHvf-i9urrYb1D2qEFWt1SnDafaq9QjtjsHwwODE" /> <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_6"> <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-week-july-1-8-what-mechanism-conduction-responsible-alternating-p-r&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20of%20the%20Week%20for%20July%201-8.%20%20What%20mechanism%20of%20conduction%20is%20responsible%20for%20the%20alternating%20P-R%20intervals%3F"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 01 Jul 2012 16:58:09 +0000 jer5150 243 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-july-1-8-what-mechanism-conduction-responsible-alternating-p-r#comments