ECG Guru - Instructor Resources - Left axis deviation https://www.ecgguru.com/ecg/left-axis-deviation en Atrial Flutter With Right Bundle Branch Block and Left Anterior Fascicular Block In a Patient With Preexisting RBBB + LAFB https://www.ecgguru.com/blog/atrial-flutter-right-bundle-branch-block-and-left-anterior-fascicular-block-patient-preexisting <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/atrial-flutter-right-bundle-branch-block-and-left-anterior-fascicular-block-patient-preexisting"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/RSB%20und%20LAH.jpg" width="3297" height="1784" 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>If a wide complex tachycardia occurs, the probability is very high that it is a ventricular tachycardia (approx. 80%, in patients with a previous myocardial infarction (...) approx. 90%). Here we see a broad complex tachycardia that looks like an RBBB + LAFB, which is regular. In this constellation, 3 causes must be considered:<br /> 1. fascicular tachycardia from the left posterior fascicle of the left tawara fascicle (QRS width usually only around 130 ms, but sometimes significantly longer).<br /> 2. AT/AFL with 2:1 conduction in the case of pre-existing bifascicular block<br /> 3. AT/ AFL with 2:1 conduction in the case of functional bifascicular block (i.e. first generated by the tachycardia) </p> <p>In this ECG, it is very difficult to recognize atrial activity. After electrical cardioversion of the existing atrial flutter with 2:1 conduction in this case, this patient showed a picture of SR with RBBB + LAFB.</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/74/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 Atrial Flutter With Right Bundle Branch Block and Left Anterior Fascicular Block In a Patient With Preexisting RBBB + LAFB 1/5</option><option value="40">Give Atrial Flutter With Right Bundle Branch Block and Left Anterior Fascicular Block In a Patient With Preexisting RBBB + LAFB 2/5</option><option value="60">Give Atrial Flutter With Right Bundle Branch Block and Left Anterior Fascicular Block In a Patient With Preexisting RBBB + LAFB 3/5</option><option value="80" selected="selected">Give Atrial Flutter With Right Bundle Branch Block and Left Anterior Fascicular Block In a Patient With Preexisting RBBB + LAFB 4/5</option><option value="100">Give Atrial Flutter With Right Bundle Branch Block and Left Anterior Fascicular Block In a Patient With Preexisting RBBB + LAFB 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.7</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" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-E87VUL8lMVNfZ6vOv7FlafYblauK8VNUtiUT7OYNP4w" /> <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%2Fatrial-flutter-right-bundle-branch-block-and-left-anterior-fascicular-block-patient-preexisting&amp;title=Atrial%20Flutter%20With%20Right%20Bundle%20Branch%20Block%20and%20Left%20Anterior%20Fascicular%20Block%20In%20a%20Patient%20%20With%20Preexisting%20RBBB%20%2B%20LAFB"><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> Mon, 18 Dec 2023 17:14:52 +0000 Dr A Röschl 888 at https://www.ecgguru.com https://www.ecgguru.com/blog/atrial-flutter-right-bundle-branch-block-and-left-anterior-fascicular-block-patient-preexisting#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/74/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 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--2" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-kfIiGLZLcwHC-J3L0UM5dsoN2k-9gOtzPs3dUopXR-Y" /> <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_2"> <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 Bifascicular Block https://www.ecgguru.com/ecg/bifascicular-block-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/bifascicular-block-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Bifascicular%20Block.jpg" width="1894" height="677" 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;"><span style="color: #00b050;">This ECG is from a 77 year old woman&nbsp;</span></strong>who was brought to the Emergency Department by EMS. She was found to be suffering from sepsis.</p><p class="MsoNormal" style="margin-bottom: .0001pt;"><strong style="mso-bidi-font-weight: normal;"><span style="color: #00b050;">ECG Interpretation&nbsp; &nbsp; &nbsp;&nbsp;</span></strong><span style="font-size: 13.008px;">The ECG shows the expected sinus tachycardia at 123 beats per minute.</span><span style="font-size: 13.008px;">&nbsp; </span><span style="font-size: 13.008px;">There is significant baseline artifact, of the type usually seen with muscle tension.</span><span style="font-size: 13.008px;">&nbsp; </span><span style="font-size: 13.008px;">The artifact makes it difficult to assess P waves and PR intervals.</span></p><p class="MsoNormal">&nbsp;</p><p class="MsoNormal">What we do see is <strong style="mso-bidi-font-weight: normal;">RIGHT BUNDLE BRANCH BLOCK</strong> and <strong style="mso-bidi-font-weight: normal;">LEFT ANTERIOR HEMIBLOCK</strong>, also called <strong style="mso-bidi-font-weight: normal;">LEFT</strong> <strong style="mso-bidi-font-weight: normal;">ANTERIOR FASCICULAR BLOCK</strong>.<span style="mso-spacerun: yes;">&nbsp; </span>Together, these are called <strong style="mso-bidi-font-weight: normal;">BIFASCICULAR BLOCK</strong>.<span style="mso-spacerun: yes;">&nbsp; </span>Most people have three main fascicles in the interventricular conduction system:<span style="mso-spacerun: yes;">&nbsp; </span>the right bundle branch and the two branches of the left bundle branch, the anterior-superior fascicle and the posterior-inferior fascicle.<span style="mso-spacerun: yes;">&nbsp; </span>In bifascicular block, two of the three are blocked.</p><p class="MsoNormal" style="margin-bottom: .0001pt;"><strong>The ECG criteria for right bundle branch block are:</strong></p><p class="MsoNormal" style="margin-bottom: .0001pt;"><span style="font-size: 13.008px;">&nbsp; &nbsp; &nbsp;</span><span style="font-size: 13.008px;">*</span><span style="font-size: 13.008px;">&nbsp;&nbsp;&nbsp;&nbsp; </span><span style="font-size: 13.008px;">wide QRS (</span><span style="font-size: 13.008px; text-decoration: underline;">&gt;</span><span style="font-size: 13.008px;">&nbsp;</span><span style="font-size: 13.008px;">.12 seconds)</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;">&nbsp;</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>*<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>rSR’ pattern in V<sub>1 .<span style="mso-spacerun: yes;">&nbsp; </span></sub>(the initial R wave may be hard to see, but the QRS will be predominantly&nbsp;<span style="font-size: 13.008px;">upright.</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;">&nbsp;</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>*<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>wide little S wave in Leads I and V<sub>6</sub>.<span style="font-size: 13.008px;">&nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px;"><br /></span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><strong>The ECG criteria for left anterior hemiblock are:</strong></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>*<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>left axis deviation ( between -45 degrees and -90 degrees)</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>*<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>small q waves in Leads I and aVL</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>*<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>small r waves with deep S waves in Leads II, III, and aVF.</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>*<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>delayed intrinsicoid deflection in aVL (the time between the onset of the QRS and the peak of the&nbsp;<span style="font-size: 13.008px;">R wave is greater than .045 seconds).</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;">&nbsp;<span style="mso-spacerun: yes;">&nbsp; &nbsp; &nbsp;</span><span style="font-size: 13.008px;">*</span><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span><span style="font-size: 13.008px;">increased voltage in the limb leads may cause aVL to meet voltage criteria for left ventricular&nbsp;</span><span style="font-size: 13.008px;">hypertrophy, but there will be no strain pattern.</span><span style="font-size: 13.008px;">&nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px;"><br /></span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;">Other causes of left axis deviation should be ruled out before diagnosing left anterior hemiblock. For example, the pathological Q waves of advanced inferior wall M.I. can cause left axis deviation, as electrical forces diminish in the damaged tissue.</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px;">Most of this ECG’s J points are at or near the baseline, with some ST depression seen in V</span><sub>2</sub><span style="font-size: 13.008px;"> through V</span><sub>4</sub><span style="font-size: 13.008px;">.</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;">&nbsp;</p><p class="MsoNormal"><span style="mso-spacerun: yes;">&nbsp;</span><em style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; line-height: 107%;">Our thanks to Jonathan Hamilton for donating this ECG</span></em></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/74/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 Bifascicular Block 1/5</option><option value="40">Give Bifascicular Block 2/5</option><option value="60">Give Bifascicular Block 3/5</option><option value="80" selected="selected">Give Bifascicular Block 4/5</option><option value="100">Give Bifascicular Block 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4</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-QVCvoa0CU8rXIkfd9049pVwv8LDx2UDYY0sUrhpexec" /> <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/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-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/left-axis-deviation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left axis deviation</a></div><div class="field-item odd"><a href="/ecg/rbbb" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">RBBB</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%2Fbifascicular-block-0&amp;title=Bifascicular%20Block"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Fri, 16 Nov 2018 20:35:40 +0000 Dawn 761 at https://www.ecgguru.com https://www.ecgguru.com/ecg/bifascicular-block-0#comments Left Bundle Branch Block https://www.ecgguru.com/ecg/left-bundle-branch-block-3 <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/left-bundle-branch-block-3"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/LB118.jpg" width="1631" height="1186" 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 was taken from an unknown patient.&nbsp; It shows sinus tachycardia with left bundle branch block. The ECG criteria for left bundle branch block are:<span style="font-size: 8pt;">&nbsp;</span></p><p class="MsoNormal">* Wide QRS (.12 seconds or greater)</p><p class="MsoNormal"><span style="font-size: 13.008px;">* Negative QRS deflection in V1</span></p><p class="MsoNormal">* Positive QRS in Leads I and V6<span style="font-size: 8pt;">&nbsp;</span></p><p class="MsoNormal"><span style="font-size: 8pt;">* Supraventricular rhythm</span></p><p class="MsoNormal">In addition to these criteria, left bundle branch block will cause repolarization abnormalities.&nbsp; This is because depolarization is altered through the left ventricle, which causes repolarization to also be altered.&nbsp; Instead of the electrical impulse traveling down the left bundle branch to depolarize the left ventricle, it depolarizes the right ventricle first, then spreads cell-to-cell across the larger left ventricle. The ST and T wave changes caused by left bundle branch block are normally “discordant”.&nbsp; That is, the ST segment will be elevated in leads with negative QRS complexes, and depressed in leads with positive QRS complexes.&nbsp; This elevation and depression of the ST segment may “imitate” the changes caused by acute myocardial infarction.&nbsp; They may also work to conceal M.I. changes, as we may not recognize &nbsp;STEMI as we attribute the ST changes to the left bundle branch block itself.<span style="font-size: 8pt;">&nbsp;</span></p><p class="MsoNormal">For more on determining the presence of acute M.I. when the patient has left bundle branch block, check out these links: &nbsp;<a title="LBBB w AMI" href="https://www.ecgguru.com/ecg/lbbb-acute-mi">ECG Guru, LBBB with AMI</a>; <a title="LITFL Sgarbossa Criteria" href="http://lifeinthefastlane.com/ecg-library/basics/sgarbossa/">Life in the Fast Lane, Sgarbossa Criteria</a>;&nbsp;<a title="EMS 12 Lead Sgarbossa" href="http://www.ems12lead.com/?feb_network_search_context=blog&amp;s=sgarbossa+">EMS 12-Lead, Sgarbossa Criteria;</a>&nbsp; <a title="Dr. Smith Mod Sgarbossa" href="http://hqmeded-ecg.blogspot.com/2011/05/lbbb-is-there-stemi.html">Dr. Smith's Modified Sgarbossa Criteria</a>.<a style="font-size: 13.008px;" title="EMS 12 Lead Sgarbossa" href="http://www.ems12lead.com/?feb_network_search_context=blog&amp;s=sgarbossa+"><span style="font-size: 8.0pt; line-height: 107%;">&nbsp;</span></a></p><p class="MsoNormal">This ECG has another interesting teaching point.&nbsp; In some leads, part of the QRS is flat or nearly flat with the baseline.&nbsp; Look at Lead I for an example.&nbsp; It is very hard to tell that this represents a wide QRS.&nbsp; Fortunately, the precordial leads, especially V1 through V4, show the width better.&nbsp; In reality, all the QRS complexes represent the time it takes to depolarize the ventricles, and that time is the same, regardless of which lead you are looking in.&nbsp; Some leads are just easier than others.&nbsp; It often helps to look at the QRSD (QRS duration) at the top of the page to see how the computer measured the QRS duration.&nbsp; It is usually accurate.&nbsp; In the illustrated case, the QRSD is measured in milliseconds, 124 ms (or .124 seconds).<span style="font-size: 13.008px;">&nbsp;</span><span style="font-size: 13.008px;">&nbsp;</span></p><p class="MsoNormal">You might also notice that the frontal plane axis is shifted to the left.&nbsp; That is, Lead II (viewpoint from left leg) has a negative QRS while Leads I and aVL (from left arm) are positive.&nbsp; This is common in left bundle branch block, because the left ventricle is being depolarized from the right ventricle, which is located inferior and medial. Because axis is affected by many factors, left axis deviation is not a prerequisite for the diagnosis of left bundle branch block.</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/74/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 Left Bundle Branch Block 1/5</option><option value="40">Give Left Bundle Branch Block 2/5</option><option value="60" selected="selected">Give Left Bundle Branch Block 3/5</option><option value="80">Give Left Bundle Branch Block 4/5</option><option value="100">Give Left Bundle Branch Block 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >2.5</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--4" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-dJLYoiQh_EpaTcDvWaB1rkCos6Jx5HSRZ3LIzVDOnwI" /> <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/left-bundle-branch-block-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left bundle branch block</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/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_4"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fleft-bundle-branch-block-3&amp;title=Left%20Bundle%20Branch%20Block"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Wed, 18 Jan 2017 00:36:28 +0000 Dawn 723 at https://www.ecgguru.com https://www.ecgguru.com/ecg/left-bundle-branch-block-3#comments Previous Inferior Wall M.I. and Left Axis Deviaton https://www.ecgguru.com/ecg/instructors-collection-ecg-week-january-17-2014-previous-inferior-wall-mi-and-left-axis-deviat-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/instructors-collection-ecg-week-january-17-2014-previous-inferior-wall-mi-and-left-axis-deviat-1"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/IW117.jpg" width="1800" height="1406" alt="" /></a></div><div class="field-item odd"><a href="/ecg/instructors-collection-ecg-week-january-17-2014-previous-inferior-wall-mi-and-left-axis-deviat-1"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Axis%20around%20-70%20ALAD.jpg" width="400" height="359" 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>If you are teaching frontal plane axis to your students, you will need to teach them HOW to determine the axis - usually beginning with the QRS axis and then adding the P and T waves. &nbsp;But, you also need to teach them WHY we measure axis, to provide relevance to something that may seem challenging to beginners. &nbsp;There are many ECG interpretations that rely heavily or are dependent upon the determination of the axis. &nbsp;</p><p>This ECG is a great example of left axis deviation. &nbsp;The cause is readily discernible, if your students know the ECG signs of myocardial infarction. This patient had an inferior wall M.I. in the distant past, and now has pathological Q waves in Leads II, III, and aVF. &nbsp;Pathological Q waves in related leads in a patient with history of M.I. are a sign of necrosis, or permanent damage, in that part of the heart. &nbsp;The inferior wall has lost an extensive amount of tissue, which is now electrically inactive as well as mechanically inactive. &nbsp;(You may also find it helpful to show students videos of ventriculograms showing<a title="Normal LV gram " href="http://ecgguru.com/ecg-resource/normal-ventriculogram"> normal LV function</a> and <a title="Hypokinesis of LV" href="http://ecgguru.com/ecg-resource/ventriculogram-stunned-inferior-wall">hypokinesis of the LV</a> due to M.I.) &nbsp;Because of the loss of electrical activity in the inferior wall, the "mean" electrical direction (or axis) is AWAY from the inferior wall. &nbsp;That is, the electricity travels AWAY from II, III, and aVF and TOWARD I and aVL.</p><p>Many of the blogs and webpages listed in our "Favorites" address the subject of axis determination. &nbsp;Here is one from <a title="Cardio Rhythms Online" href="http://cardiorhythmsonline.blogspot.co.uk/">Cardio Rhythms Online</a> if you would like a review.</p><p>&nbsp;</p><p>&nbsp;</p><p>&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/74/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 Previous Inferior Wall M.I. and Left Axis Deviaton 1/5</option><option value="40">Give Previous Inferior Wall M.I. and Left Axis Deviaton 2/5</option><option value="60">Give Previous Inferior Wall M.I. and Left Axis Deviaton 3/5</option><option value="80">Give Previous Inferior Wall M.I. and Left Axis Deviaton 4/5</option><option value="100">Give Previous Inferior Wall M.I. and Left Axis Deviaton 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--5" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-LOxRobPeD3viTsL67Fy_bepklkmN6__rthX9eXVm0HM" /> <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/inferior-wall-mi-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Inferior Wall M.I.</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/pathological-q-waves" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pathological Q waves</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%2Finstructors-collection-ecg-week-january-17-2014-previous-inferior-wall-mi-and-left-axis-deviat-1&amp;title=Previous%20Inferior%20Wall%20M.I.%20and%20Left%20Axis%20Deviaton"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sat, 18 Jan 2014 03:39:39 +0000 Dawn 546 at https://www.ecgguru.com https://www.ecgguru.com/ecg/instructors-collection-ecg-week-january-17-2014-previous-inferior-wall-mi-and-left-axis-deviat-1#comments Jason's Blog: ECG Challenge of the Week for August 19-26. The value of a previous, comparative ECG. https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-august-19-26-value-previous-comparative-ecg <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-august-19-26-value-previous-comparative-ecg"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201i%20answer.png" width="765" height="1007" 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><br><br></strong></span><span style="text-decoration: underline;"><strong>Patient clinical data:</strong></span>&nbsp; 68-year-old black man.<br><br><span style="text-decoration: underline;"><strong>Question:</strong></span> <br>(1.)&nbsp; What "pseudo" clue in Fig. 1 clinches the source of the mechanism seen in Fig. 2?</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/74/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 August 19-26. The value of a previous, comparative ECG. 1/5</option><option value="40" selected="selected">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for August 19-26. The value of a previous, comparative ECG. 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for August 19-26. The value of a previous, comparative ECG. 3/5</option><option value="80">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for August 19-26. The value of a previous, comparative ECG. 4/5</option><option value="100">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for August 19-26. The value of a previous, comparative ECG. 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >1.5</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--6" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-EWswr-LqukkLa8Sx4vlBfVg079DiH9czEHBBthFmp2Y" /> <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-august-19-26-value-previous-comparative-ecg&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20of%20the%20Week%20for%20August%2019-26.%20The%20value%20of%20a%20previous%2C%20comparative%20ECG."><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Mon, 20 Aug 2012 02:19:18 +0000 jer5150 306 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-august-19-26-value-previous-comparative-ecg#comments Jason's Blog: ECG Challenge of the Week for July 8-15. Which lead do both of these ECGs share a “common-thread”? https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-july-8-15-which-lead-do-both-these-ecgs-share-%E2%80%9Ccommon-thread%E2%80%9D <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-8-15-which-lead-do-both-these-ecgs-share-%E2%80%9Ccommon-thread%E2%80%9D"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201d.png" width="765" height="835" 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>&nbsp;</p> <p class="MsoNormal"><span style="font-family: times new roman,times; font-size: medium;"><span style="line-height: 115%;">Two more ECGs classified under the general heading:&nbsp; </span><span style="line-height: 115%;"><em>“Tracing suggestive of &nbsp;&nbsp;____ ”</em></span></span><span style="font-family: times new roman,times; font-size: medium;">.&nbsp; I&nbsp; like ECGs that strongly favor a very specific clinical disorder. </p> <p> </span><span style="font-family: times new roman,times;"><span style="font-size: medium;">Recently I performed these ECGs on two different patients.&nbsp; They were both recorded a little more than an hour apart and exemplified a common electrocardiographic theme I noticed during that work shift.</span><span style="font-size: medium;"></p> <p></span></span><span style="font-size: medium; font-family: times new roman,times;"><span style="line-height: 115%;">The primary goal of this week’s blog is <em>not</em> to determine the name of each ECG’s rhythm but rather what each ECG is virtually diagnostic of.</span></span><span style="font-size: medium;"><span style="line-height: 115%;"></span></span><span style="font-family: times new roman,times; font-size: medium;"><span style="line-height: 115%;"></p> <p></span></span><span style="font-family: times new roman,times;"><span style="font-size: medium;"><span style="line-height: 115%;">This </span></span><span style="font-size: medium;"><span style="line-height: 115%;"><em>sign</em> is commonly referred to by one of two names:&nbsp; (1.)&nbsp; Either by the <em>lead</em> that it appears in or (2.) <em>eponymously</em></span></span><span style="font-size: medium;"><span style="line-height: 115%;"> named after the doctor who is credited with first describing it.</span></span></span><span style="font-family: times new roman,times; font-size: medium;"><span style="line-height: 115%;"> &nbsp; </span></span></p> <p><span style="font-family: times new roman,times;"><span style="font-size: medium;"><span style="line-height: 115%;">To date, the ECG machine's computer is not programmed to recognize this particular sign<strong>/</strong>pattern nor will it make the suggestion to consider this possibile clinical disorder in it's statements printed at the top of ECG</span></span><span style="font-size: medium;"><span style="line-height: 115%;">.&nbsp; Hopefully, in the future, manufacturers of ECG machines will add this algorithm to their computer's diagnostic statements.<br /></span></span></span><span style="font-family: times new roman,times; font-size: medium;"><br /> </span><span style="font-size: medium; font-family: times new roman,times;"><strong><span style="text-decoration: underline;">Patients’ clinical data:</span></strong></span><span style="font-family: times new roman,times; font-size: medium;"><br /> </span></p> <!--[if gte mso 9]><p><xml><br /> <o:OfficeDocumentSettings><br /> <o:RelyOnVML/><br /> <o:AllowPNG/><br /> </o:OfficeDocumentSettings><br /> </xml><![endif]--></p> <!--[if gte mso 9]><p><xml><br /> <w:WordDocument><br /> <w:View>Normal</w:View><br /> <w:Zoom>0</w:Zoom><br /> <w:TrackMoves/><br /> <w:TrackFormatting/><br /> 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Priority="37" Name="Bibliography"/><br /> <w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/><br /> </w:LatentStyles><br /> </xml><![endif]--></p> <!--[if gte mso 10]><style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} </style><p><![endif]--></p> <ul> <li><strong><span style="text-decoration: underline;"><span style="font-size: 12pt; line-height: 115%; font-family: 'Times New Roman','serif'; color: blue;">Fig. 1</span></span></strong><span style="font-family: times new roman,times;"><span style="text-decoration: underline;"><span style="font-size: medium;"><strong><span style="color: blue; text-decoration: underline;"></span></strong></span></span><span style="font-size: medium;">&nbsp;(Top tracing): 61-year-old black man, underweight, active smoker (long history of tobacco abuse), and persistent <em>cough</em>.&nbsp; The challenge for me was to obtain an artifact-free tracing in between coughing fits.&nbsp;</span></span><span style="font-family: times new roman,times;"><span style="font-size: medium;">When asked, this patient<em> </em>denied having this medical condition that his provider had diagnosed him with.</span></span></li> </ul> <ul> <li><strong><span style="text-decoration: underline;"><span style="font-size: 12pt; line-height: 115%; font-family: 'Times New Roman','serif'; color: blue;">Fig. 2</span></span></strong><span style="font-family: times new roman,times;"><span style="text-decoration: underline;"><span style="font-size: medium;"><strong><span style="color: blue; text-decoration: underline;"></span></strong></span></span><span style="font-size: medium;"> (Bottom tracing): 70-year-old white man, active smoker (long history of tobacco abuse).&nbsp; When asked, this patient <em>also</em> denied having this medical condition that his provider had diagnosed him with.</span></span></li> </ul> <p><span style="font-family: times new roman,times;"><span style="font-size: medium;">Personally, I think that a certain degree of denial goes hand-in-hand in this patient population when confronted with their self-destructive vices.<br /></span><span style="font-size: medium;"><br /> </span></span><span style="font-size: medium; font-family: times new roman,times;">So, both men have similar (albeit limited) histories and a similar clue on their ECGs.</span><span style="font-family: times new roman,times;"><span style="font-size: medium;">&nbsp; </span></span><span style="font-size: medium; font-family: times new roman,times;">In each of the two ECGs, there is a single lead where the waveforms look nearly identical.</span><span style="font-family: times new roman,times;"><span style="font-size: medium;"> </span></span><span style="font-family: times new roman,times;"><span style="font-size: medium;"><br /> </span></span></p> <ul> <li><span style="font-family: times new roman,times;"><span style="font-size: medium;"><strong><span style="text-decoration: underline;"><span style="color: #00b050;">Hint # 1:</span></span></strong></span><span style="font-size: medium;">&nbsp; The answer to the clinical disorder is a 4-letter acronym.</span><span style="font-size: medium;"></span></span></li> </ul> <ul> <li><span style="font-family: times new roman,times;"><span style="font-size: medium;"><strong><span style="text-decoration: underline;"><span style="color: #00b050;">Hint # 2:</span></span></strong></span><span style="font-size: medium;">&nbsp; The only thing that superficially mimics this pattern is simultaneously switching the arm cables with their respective leg cables on the same side (i.e., <a href="http://lifeinthefastlane.com/wp-content/uploads/2011/12/bilateral-arm-leg-reversal.jpg" target="_blank">RA reversed with RL <em>and</em></a></span><span style="font-size: medium;"><a href="http://lifeinthefastlane.com/wp-content/uploads/2011/12/bilateral-arm-leg-reversal.jpg" target="_blank"> LA reversed with LL</a>)</span></span></li> </ul> <p><span style="font-family: times new roman,times;"><span style="font-size: medium;"><strong><span style="text-decoration: underline;"><span style="color: red;"> </span></span></strong></span></span><span style="font-family: times new roman,times;"><span style="font-size: medium;"><strong><span style="text-decoration: underline;"><span style="color: red;">Questions:</span></span></strong></span><span style="font-size: medium;"><span style="line-height: 115%;"><br /></span></span></span></p> <ul> <li><span style="font-family: times new roman,times;"><span style="font-size: medium;"><span style="line-height: 115%;">(1.)&nbsp; Which one of the 12 individual leads am I referring to<em> and<strong> . . .</strong></em></span></span></span></li> <li><span style="font-family: times new roman,times;"><span style="font-size: medium;"><span style="line-height: 115%;">(2.)&nbsp; What clinical disorder is that lead a highly specific marker of?</span></span></span><span style="font-family: times new roman,times;"><span style="font-size: medium;"><span style="line-height: 115%;"><br /></span></span></span></li> </ul> </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/74/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 Jason&amp;#039;s Blog: ECG Challenge of the Week for July 8-15. Which lead do both of these ECGs share a “common-thread”? 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for July 8-15. Which lead do both of these ECGs share a “common-thread”? 2/5</option><option value="60" selected="selected">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for July 8-15. Which lead do both of these ECGs share a “common-thread”? 3/5</option><option value="80">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for July 8-15. Which lead do both of these ECGs share a “common-thread”? 4/5</option><option value="100">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for July 8-15. Which lead do both of these ECGs share a “common-thread”? 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >2.8</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--7" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-9DmulVNmXfUz8iWktRhv2c4LvKoR9TgP2z-n35m43JY" /> <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_7"> <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-8-15-which-lead-do-both-these-ecgs-share-%25E2%2580%259Ccommon-thread%25E2%2580%259D&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20of%20the%20Week%20for%20July%208-15.%20Which%20lead%20do%20both%20of%20these%20ECGs%20share%20a%20%E2%80%9Ccommon-thread%E2%80%9D%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, 08 Jul 2012 00:38:05 +0000 jer5150 246 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-july-8-15-which-lead-do-both-these-ecgs-share-%E2%80%9Ccommon-thread%E2%80%9D#comments Jason's Blog: ECG Challenge of the Week for June 10-17. Why did the ventricular rate abruptly decrease? https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-june-10-17-why-did-ventricular-rate-abruptly-decrease <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-june-10-17-why-did-ventricular-rate-abruptly-decrease"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Answer%20with%20laddergram-1a.png" width="765" height="499" 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>&nbsp;</p> <p><em style="font-family: 'Times New Roman', serif; line-height: 115%; font-size: medium;"><strong>From June 10, 2012:</strong></em><span style="font-family: 'Times New Roman', serif; line-height: 115%; font-size: medium;"> &nbsp; As is the case with all practical blogs, I’m encouraging ECG Guru members to engage in active group participation.&nbsp; Share your thoughts, observations, impressions, findings, and interpretations.&nbsp; Feel free to compare notes with one another and pick each other’s brains.</span></p> <p><span style="font-size: medium;"><span style="line-height: 115%; font-family: 'Times New Roman','serif';"><br></span><span style="line-height: 115%; font-family: 'Times New Roman','serif';">Please post your comments and inquiries and I guarantee I'll respond to them in a timely manner as soon as they are received (usually within a few short hours).&nbsp; All questions will be answered and the interpretation (accompanied by laddergram) will be revealed on Sunday, June 17 2012 at which time I will post a brand new Case of the Week.&nbsp;</span><span style="line-height: 115%; font-family: 'Times New Roman','serif';"> <br><br></span></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/74/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 Jason&amp;#039;s Blog: ECG Challenge of the Week for June 10-17. Why did the ventricular rate abruptly decrease? 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for June 10-17. Why did the ventricular rate abruptly decrease? 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for June 10-17. Why did the ventricular rate abruptly decrease? 3/5</option><option value="80">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for June 10-17. Why did the ventricular rate abruptly decrease? 4/5</option><option value="100">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for June 10-17. Why did the ventricular rate abruptly decrease? 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--8" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-Ab4YvldYOAYYbUO2TpbS6JZFXKlNRuxa685RdBmFU4g" /> <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_8"> <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-june-10-17-why-did-ventricular-rate-abruptly-decrease&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20of%20the%20Week%20for%20June%2010-17.%20%20Why%20did%20the%20ventricular%20rate%20abruptly%20decrease%3F"><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 Jun 2012 23:38:48 +0000 jer5150 223 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-june-10-17-why-did-ventricular-rate-abruptly-decrease#comments