ECG Guru - Instructor Resources - Right axis deviation https://www.ecgguru.com/ecg/right-axis-deviation en Narrow-complex Tachycardia In An Infant https://www.ecgguru.com/ecg/narrow-complex-tachycardia-infant <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/narrow-complex-tachycardia-infant"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Peds100.jpg" width="1800" height="1227" 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><span style="font-size: 16.0pt; line-height: 107%; color: #00b050;">The patient:<span style="mso-spacerun: yes;">&nbsp; </span></span></strong><span style="font-size: 12.0pt; line-height: 107%;">This ECG was obtained from a two-month-old girl who was a patient in the Emergency Department.<span style="mso-spacerun: yes;">&nbsp; </span>She had a fever due to a respiratory infection and was dehydrated. She was alert, active, and irritable.</span></p><p class="MsoNormal"><strong><span style="font-size: 16.0pt; line-height: 107%; color: #00b050;">The ECG:<span style="mso-spacerun: yes;">&nbsp; </span></span></strong><span style="font-size: 12.0pt; line-height: 107%; color: black; mso-themecolor: text1;">There is a narrow-complex tachycardia at a rate of 194 bpm.<span style="mso-spacerun: yes;">&nbsp; </span>This is faster than the normal range for a two-month-old, which is about 80-160 bpm.<span style="mso-spacerun: yes;">&nbsp; </span>The intervals are all within normal range.<span style="mso-spacerun: yes;">&nbsp; </span>The frontal plane axis, at 145 degrees, is rightward, which is normal for this age. There are prominent, narrow Q waves in the inferior wall leads (II, III, and aVF) and in the left lateral leads (V4, V5, and V6).<span style="mso-spacerun: yes;">&nbsp; </span>There are no Q waves in the high lateral leads (I and aVL).<span style="mso-spacerun: yes;">&nbsp; </span>This is a normal pattern for this age group.<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span><a href="http://www.sciencedirect.com/science/article/pii/B9781416037743100280">www.sciencedirect.com/science/article/pii/B9781416037743100280</a></span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%; color: black; mso-themecolor: text1;">The evaluation of this ECG must be preceded by a thorough evaluation of the patient.<span style="mso-spacerun: yes;">&nbsp; </span>SINUS TACHYCARDIA would be expected in the setting of fever, dehydration, hypoxia, pain or other discomfort. Should the rate fail to gradually return to a normal range after treatment, we would have to consider a reentrant supraventricular tachycardia. Reentrant tachycardias have a SUDDEN ONSET and SUDDEN TERMINATION.</span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%; color: black; mso-themecolor: text1;">Unfortunately, we do not have follow up on the patient.</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/95/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 Narrow-complex Tachycardia In An Infant 1/5</option><option value="40">Give Narrow-complex Tachycardia In An Infant 2/5</option><option value="60">Give Narrow-complex Tachycardia In An Infant 3/5</option><option value="80" selected="selected">Give Narrow-complex Tachycardia In An Infant 4/5</option><option value="100">Give Narrow-complex Tachycardia In An Infant 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.4</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" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-Y-cNgzqwJpIaUGksXdpgTbkEpQcsUuDvpNybauFCblY" /> <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/sinus-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Sinus tachycardia</a></div><div class="field-item odd"><a href="/ecg/paroxysmal-supraventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Paroxysmal supraventricular tachycardia</a></div><div class="field-item even"><a href="/ecg/pediatric-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pediatric ECG</a></div><div class="field-item odd"><a href="/ecg/q-waves" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Q waves</a></div><div class="field-item even"><a href="/ecg/right-axis-deviation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Right axis deviation</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fnarrow-complex-tachycardia-infant&amp;title=%20Narrow-complex%20Tachycardia%20In%20An%20Infant"><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> Tue, 26 Oct 2021 20:20:58 +0000 Dawn 808 at https://www.ecgguru.com https://www.ecgguru.com/ecg/narrow-complex-tachycardia-infant#comments Tachycardia In An Unresponsive Patient https://www.ecgguru.com/ecg/tachycardia-unresponsive-patient <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/tachycardia-unresponsive-patient"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Tachycardia%20and%20Hyperkalemia.jpg" width="1800" height="713" 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;">&nbsp;</strong><strong style="font-size: 13.008px;"><span style="font-size: 10.0pt; line-height: 107%; color: #00b050;">The Patient</span></strong><span style="font-size: 10pt; line-height: 107%; color: #00b050;">&nbsp;&nbsp;&nbsp;&nbsp; </span><span style="font-size: 10pt; line-height: 107%;">This ECG was obtained from a 28-year-old woman who was found in her home, unresponsive.&nbsp; She was hypotensive at 99/35.&nbsp; No one was available to provide information about past medical history or the onset of this event.</span></p><p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">Before you read my comments, pause to look at the ECG and see what YOU think.<span style="mso-spacerun: yes;">&nbsp; </span>We would welcome comments below from all our members!</span></p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; line-height: 107%; color: #00b050;">The ECG</span></strong><span style="font-size: 10.0pt; line-height: 107%; color: #00b050;"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span></span><span style="font-size: 10.0pt; line-height: 107%;">This ECG is quite challenging, as it illustrates the helpfulness of ECG changes in patient diagnosis, and also points out how important clinical correlation is when the ECG suggests multiple different problems. Forgive me in advance, but there is a lot to say about this ECG.</span></p><p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">The <strong style="mso-bidi-font-weight: normal;">heart rate</strong> is 148 bpm, and the <strong style="mso-bidi-font-weight: normal;">rhythm is regular</strong>, although not perfectly. <strong style="mso-bidi-font-weight: normal;">P waves</strong> are not seen, even though the ECG machine gives a P wave axis and PR interval measurement. The rate is fast enough to bury the P waves in the preceding T waves, especially if there is first-degree AV block. <strong style="mso-bidi-font-weight: normal;"><em style="mso-bidi-font-style: normal;"><span style="color: #7030a0;">Differential dx</span></em></strong><em style="mso-bidi-font-style: normal;"><span style="color: #7030a0;">:</span></em><span style="color: #7030a0;"> sinus tachycardia, PSVT, atrial flutter. </span>The very slight irregularity points more towards sinus tachycardia.<span style="mso-spacerun: yes;">&nbsp; </span>The rate of nearly 150 suggests atrial flutter with 2:1 conduction, but the only lead that looks remotely like it has flutter waves is V2. The lack of an onset or offset of the rhythm makes it difficult to diagnose PSVT with any certainty. </span></p><p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">The ECG machine measures the QRS complex at .102 seconds (102 ms). I don’t believe this is correct, as the QRS has an additional wave due to <strong style="mso-bidi-font-weight: normal;"><a href="https://www.ecgguru.com/ecg/instructors-collection-ecg-week-september-23-2015-right-bundle-branch-block-0">right bundle branch block pattern</a></strong>, and the machine did not count this terminal wave.<span style="mso-spacerun: yes;">&nbsp; </span>I measure the actual <strong style="mso-bidi-font-weight: normal;">QRS duration</strong> at closer to .12 seconds (120 ms).<span style="mso-spacerun: yes;">&nbsp; </span>The J point, or end point of the QRS complex, is difficult to see in most of the leads because of slurring from the QRS to the ST segment.<span style="mso-spacerun: yes;">&nbsp; </span></span></p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><em style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; line-height: 107%; color: #7030a0;">Differential dx:</span></em></strong><span style="font-size: 10.0pt; line-height: 107%;"><span style="mso-spacerun: yes;">&nbsp;&nbsp; </span>There are some signs of <strong style="mso-bidi-font-weight: normal;"><a href="https://litfl.com/ecg-changes-in-pulmonary-embolism/">right ventricular failure</a></strong> on this ECG, but ECG is not 100% accurate for determining right heart strain. The ECG evidence must be confirmed by clinical correlation. <span style="mso-spacerun: yes;">&nbsp;</span>In a young person with sudden onset of right heart failure signs, one must consider <strong style="mso-bidi-font-weight: normal;">pulmonary embolus</strong>.<span style="mso-spacerun: yes;">&nbsp; </span>Some, but not all, of the ECG signs that can be associated with pulmonary embolism are:</span></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l1 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Sinus tachycardia (44%)</span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l1 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Right bundle branch block or incomplete RBBB (18%)</span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l1 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Right ventricular strain: T wave inversion in right precordial leads and inferior leads (only present here in V1 and Lead III, which is often normal).</span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l1 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Right axis deviation (16%).<span style="mso-spacerun: yes;">&nbsp; </span>Present here, but not severe at around 100 degrees.</span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l1 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">S1 – Q3 – T3 the “classic” but not often present, sign of pulmonary embolism.<span style="mso-spacerun: yes;">&nbsp; </span>The<span style="mso-spacerun: yes;">&nbsp; </span>S wave in I may simply be the RBBB and the Q wave with T wave inversion may be a normal variant.</span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l1 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Non-specific ST segment and T wave changes (50%)</span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l1 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">P pulmonale (we cannot see P waves)</span></p><p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">There are also ST and T wave changes that resemble <strong style="mso-bidi-font-weight: normal;"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6282764/">Brugada Syndrome</a>, </strong>a genetic disorder of the sodium channel that can cause sudden death.<span style="mso-spacerun: yes;">&nbsp; </span>Illness can unmask the ECG changes that point to Brugada syndrome, but also there are conditions that cause similar ECG changes without the patient actually having a channelopathy. The shape of the ST and inverted T wave in V1 here are “Brugada like”. In Brugada Syndrome, those changes are usually seen in V1 and V2.<span style="mso-spacerun: yes;">&nbsp; </span></span></p><p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">The loss of P waves and the tall, peaked T waves with narrow bases are indicative of <strong style="mso-bidi-font-weight: normal;"><a href="https://rebelem.com/ecg-changes-hyperkalemia/">hyperkalemia</a></strong>. It is difficult to determine just from the ECG how far along the patient is in serum potassium levels, but widening of the QRS with loss of voltage is a dire sign.<span style="mso-spacerun: yes;">&nbsp; </span>Because hyperkalemia can progress swiftly to a “sine wave” pattern, it is crucial to make the diagnosis and begin treatment as soon as possible.<span style="mso-spacerun: yes;">&nbsp; </span>Usually, the serum K is high because the K has moved out of the intracellular space and entered the serum. Rather than remove K from the body, it is necessary to “push” it back into the cells, where it rightly belongs.<span style="mso-spacerun: yes;">&nbsp; </span></span></p><p class="MsoNormal" style="margin-bottom: .0001pt;"><span style="font-size: 10.0pt; line-height: 107%;">And, to make matters even more confusing, this ECG show signs of drug toxicity, specifically <strong style="mso-bidi-font-weight: normal;"><a href="https://litfl.com/tricyclic-overdose-sodium-channel-blocker-toxicity/">sodium channel blocker overdose</a>.<span style="mso-spacerun: yes;">&nbsp; </span></strong>Tricyclic antidepressants and some antiarrhythmics fall into this broad category. <span style="mso-spacerun: yes;">&nbsp;</span>Remember, this patient was found unresponsive, and we have no remote OR recent medical history.<span style="mso-spacerun: yes;">&nbsp; </span>Everything is on the table.<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span><span style="mso-spacerun: yes;">&nbsp;</span>ECG signs of sodium channel blocker OD include:</span></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo2;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Sinus tachycardia</span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo2;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Wide QRS complex</span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo2;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Prolongation of the PR interval or QT interval</span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo2;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Right bundle branch block</span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 30.75pt; mso-add-space: auto; text-indent: -.25in; mso-list: l0 level1 lfo2;"><!--[if !supportLists]--><span style="font-size: 10.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="font-size: 10.0pt; line-height: 107%;">Brugada pattern</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 10.0pt; color: #00b050;">Hospital Follow Up<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span></span></strong><span style="font-size: 10.0pt;">At this time, we have only a preliminary follow up report.<span style="mso-spacerun: yes;">&nbsp; </span>Notably, this young woman was found to be in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298445/">diabetic ketoacidosis</a>, with a blood glucose level of 1,332 mg/dL! As a result, she was also hyperkalemic, with a serum potassium of 8.2.<span style="mso-spacerun: yes;">&nbsp; </span>The severe dehydration and acidosis of DKA cause sinus tachycardia.</span></p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><em style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; line-height: 107%; color: #595959; mso-themecolor: text1; mso-themetint: 166; mso-style-textfill-fill-color: #595959; mso-style-textfill-fill-themecolor: text1; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: 'lumm=65000 lumo=35000';">Thanks to Sebastian Garay for donating this interesting ECG.</span></em></strong></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/95/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 Tachycardia In An Unresponsive Patient 1/5</option><option value="40">Give Tachycardia In An Unresponsive Patient 2/5</option><option value="60">Give Tachycardia In An Unresponsive Patient 3/5</option><option value="80" selected="selected">Give Tachycardia In An Unresponsive Patient 4/5</option><option value="100">Give Tachycardia In An Unresponsive Patient 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 >16</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-5VEMbehTdEbQfCukJJwJFxmgBphlJ2ZvSRpzfFnmBpI" /> <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/sinus-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Sinus tachycardia</a></div><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-posterior-hemiblock" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left posterior hemiblock</a></div><div class="field-item odd"><a href="/ecg/right-axis-deviation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Right axis deviation</a></div><div class="field-item even"><a href="/ecg/sa-exit-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">SA exit block</a></div><div class="field-item odd"><a href="/ecg/wide-qrs-complex" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wide QRS complex</a></div><div class="field-item even"><a href="/ecg/diabetic-ketoacidosis" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Diabetic ketoacidosis</a></div><div class="field-item odd"><a href="/ecg/hyperkalemia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Hyperkalemia</a></div><div class="field-item even"><a href="/ecg/brugada-sign" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Brugada sign</a></div><div class="field-item odd"><a href="/ecg/tricyclic-antidepressant-overdose" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Tricyclic antidepressant overdose</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%2Ftachycardia-unresponsive-patient&amp;title=Tachycardia%20In%20An%20Unresponsive%20Patient"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Wed, 21 Aug 2019 02:48:51 +0000 Dawn 775 at https://www.ecgguru.com https://www.ecgguru.com/ecg/tachycardia-unresponsive-patient#comments Jason's Blog: ECG Challenge for the month of June, 2013. https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-month-june-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-june-2013"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Month%202o%20ladder%20diagram.png" width="765" height="515" 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>Unfortunately, I have no available clinical data on this patient.&nbsp; Merely looking for an interpretation of the ECG in it's raw form.</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/95/feed" method="post" id="fivestar-custom-widget--3" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--6" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Jason&amp;#039;s Blog: ECG Challenge for the month of June, 2013. 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge for the month of June, 2013. 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge for the month of June, 2013. 3/5</option><option value="80" selected="selected">Give Jason&amp;#039;s Blog: ECG Challenge for the month of June, 2013. 4/5</option><option value="100">Give Jason&amp;#039;s Blog: ECG Challenge for the month of June, 2013. 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.9</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--3" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-2_mEd4iCpGlNz4_Oj6slFMzeqt1EJqisM6iXaG2jZ_s" /> <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-month-june-2013&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20for%20the%20month%20of%20June%2C%202013."><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Mon, 27 May 2013 17:40:26 +0000 jer5150 452 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-month-june-2013#comments Jason's Blog: ECG Challenge of the Week for Sept. 9-16. https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-sept-9-16 <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-sept-9-16"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201l%20answer.png" width="765" height="1001" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p><span style="text-decoration: underline;"><strong>Patient's clinical data:</strong></span>&nbsp; 76-year-old white man admitted to the ICU.&nbsp;&nbsp;<br><br><span style="text-decoration: underline;"><strong>Hint:</strong></span>&nbsp; In Fig. 2,&nbsp;there is an extremely subtle clue on that ECG that I almost didn't notice.&nbsp; Laddergrams will be provided for both of these as the end of the week.<br><br>What is going on here? &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/95/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 Sept. 9-16. 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Sept. 9-16. 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Sept. 9-16. 3/5</option><option value="80">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Sept. 9-16. 4/5</option><option value="100">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Sept. 9-16. 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--4" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-x_OaHXSy0j5SiGoeXAVEbb1QAYnZiGIVbCcN17EZfCA" /> <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-sept-9-16&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20of%20the%20Week%20for%20Sept.%209-16."><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Mon, 10 Sep 2012 01:02:32 +0000 jer5150 327 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-sept-9-16#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/95/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-lqjkvvapNLsoBrHmJN3b5UXzOR9wN02-GIBwodyTQB0" /> <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 All depends on how you define "degrees". https://www.ecgguru.com/blog/all-depends-how-you-define-degrees <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/all-depends-how-you-define-degrees"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Degrees.png" width="827" height="318" 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>One of our local news channels was reporting widespread and record-breaking <strong>right axis deviation</strong> throughout central Virginia. &nbsp; </p> <p><span style="text-decoration: underline;"><strong>References / Sources: <br /></strong></span>1.)&nbsp; <a href="http://www.wric.com/" target="_blank"><em>WRIC</em> Richmond News and Weather - - WRICTV8 - Home</a><br />2.)&nbsp; <a href="http://www.blaufuss.org/" target="_blank"><em>Blaufuss</em> Multimedia - Heart Sounds and Cardiac Arrhythmias</a></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/95/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 All depends on how you define &amp;quot;degrees&amp;quot;. 1/5</option><option value="40">Give All depends on how you define &amp;quot;degrees&amp;quot;. 2/5</option><option value="60">Give All depends on how you define &amp;quot;degrees&amp;quot;. 3/5</option><option value="80">Give All depends on how you define &amp;quot;degrees&amp;quot;. 4/5</option><option value="100">Give All depends on how you define &amp;quot;degrees&amp;quot;. 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-cWRFqRdBGlpdnQ9goOQFc08LDRrd-x7IE8J4xPnLoG0" /> <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%2Fall-depends-how-you-define-degrees&amp;title=All%20depends%20on%20how%20you%20define%20%22degrees%22.%20"><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 12:44:18 +0000 jer5150 242 at https://www.ecgguru.com https://www.ecgguru.com/blog/all-depends-how-you-define-degrees#comments Jason's Blog: ECG Challenge of the Week for June 17-24. What "highs" and "lows" is this tracing suggestive of? https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-june-17-24-what-highs-and-lows-tracing-suggestive <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-17-24-what-highs-and-lows-tracing-suggestive"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201b.png" width="765" height="423" 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-family: times new roman,times; font-size: medium;"><span style="line-height: 115%;">This week’s ECG is categorized under the heading:<em>“Tracing suggestive of <span style="text-decoration: underline;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span>”</em> This is a classical example of this <em>pair</em> of derangements.</span><strong><span style="text-decoration: underline;"><span style="line-height: 115%;"><br><br></span></span></strong><span style="line-height: 115%;"><strong><span style="text-decoration: underline;">Patient's clinical data:</span></strong></span><strong></strong><span style="line-height: 115%;">&nbsp; 46-year-old white man who presented to the emergency department.&nbsp; Co-morbidities include a h<em></em>istory of <em>hypertension</em>, CHF, CAD, Type II DM, and <em>diabetic nephropathy</em> in addition to one other major problem.<br><br><strong><span style="text-decoration: underline;">Questions:</span></strong>&nbsp; What <em>combination</em> of effects are present and what <em>chronic</em> problem are they <em>both</em> typically associated with?&nbsp; What clinical procedure has this patient been routinely undergoing and now needs to have STAT?</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/95/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 June 17-24. What &amp;quot;highs&amp;quot; and &amp;quot;lows&amp;quot; is this tracing suggestive of? 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for June 17-24. What &amp;quot;highs&amp;quot; and &amp;quot;lows&amp;quot; is this tracing suggestive of? 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for June 17-24. What &amp;quot;highs&amp;quot; and &amp;quot;lows&amp;quot; is this tracing suggestive of? 3/5</option><option value="80" selected="selected">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for June 17-24. What &amp;quot;highs&amp;quot; and &amp;quot;lows&amp;quot; is this tracing suggestive of? 4/5</option><option value="100">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for June 17-24. What &amp;quot;highs&amp;quot; and &amp;quot;lows&amp;quot; is this tracing suggestive of? 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.3</span></span> <span class="total-votes">(<span >4</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-gVK3G7R7gXw14Js48hYdPuGFECB2dqiRBfJhTuFyDFc" /> <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-june-17-24-what-highs-and-lows-tracing-suggestive&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20of%20the%20Week%20for%20June%2017-24.%20%20What%20%22highs%22%20and%20%22lows%22%20is%20this%20tracing%20suggestive%20of%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, 17 Jun 2012 04:00:17 +0000 jer5150 227 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-june-17-24-what-highs-and-lows-tracing-suggestive#comments Question: Does an extreme right axis (backward) always indicate a ventricular rhythm? https://www.ecgguru.com/expert-review/question-does-extreme-right-axis-backward-always-indicate-ventricular-rhythm <div class="field field-name-field-expert-ecg-interpretation field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Headshot_0.jpg" width="110" height="100" alt="" /></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>Today's expert is Jason E. Roediger, CCT, CRAT, who is a highly respected Cardiovascular Technician at the Dept. of Veterans Affairs, Hunter Holmes McGuire VA Medical Center in Richmond, VA. He is known for holding numerous certifications in all levels of ECG interpretation, and also for scoring 100% on the Level IV Advanced ECG Board Certification exam that is usually reserved for cardiologists.<br />  </p> <p> <strong>Answer:</strong> Always? No. Usually, Yes.<br /> There are exceptions to several "golden rules" in electrocardiography and this one is not exempt. One of the chronic issues contributing towards widespread confusion in understanding electrical axis is a lack of continuity in terminology. There is no general concensus on how to refer to an axis in the right upper quadrant. Depending on which author you are reading, it has traditionally been known by multiple names: Northwest axis. . . upper right quadrant. . . extreme right axis. . . right superior axis. . . "no-man's-land" (i.e., "N-M-L".). . . etc. Because my first exposure to electrical axis was through Dr. Marriott's textbooks and he prefered to use "N-M-L", I have personally latched on to that particular name as well. Even though some persist in calling it an "extreme left axis" or "far left axis deviation", this practice is frowned upon and discouraged. It's important to note that an axis in "N-M-L" is not synonymous with an "indeterminate" axis which occurs when the QRS is essentially isodiphasic or equphasic in all 6 limb leads and therefore the polarity of the QRS cannot be discerned in leads I and aVF.</p> <p> <strong>Definition:</strong> An axis in "N-M-L" is recognized when the QRS complex has a predominantly or wholly negative deflection (i.e., down) in leads I and aVF. The axis is −90 to −180 degrees.</p> <p> Irregardless of which descriptive name you prefer, in the context of a wide QRS complex tachycardia, this particular axis is highly predictive of ventricular tachycardia and is rarely encountered in "conducted" rhythms however some examples of aberrant SVT have been published with an axis in "N-M-L".</p> <p> <strong>In summary: </strong>An axis in "N-M-L" implies (but is not proof of) an apical origin to the rhythm and should make one think of and exclude the possibility of ventricular tachycardia. As a general rule, until it is proven otherwise, assume any wide QRS complex tachycardia is ventricular tachycardia. Even though this one clue carries significant weight in supporting the interpretation of ventricular tachycardia, that conclusion can not be made based solely on this single criteria. This axis is just one of a long list of criteria and should be used in conjunction with all of them as they carry alot of strength when used collectively.<br />  </p> </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-axis-deviation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Right axis deviation</a></div><div class="field-item odd"><a href="/ecg/extreme-right-axis-deviation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Extreme right axis deviation</a></div><div class="field-item even"><a href="/ecg/ventricular-rhythm" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ventricular rhythm</a></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%2Fexpert-review%2Fquestion-does-extreme-right-axis-backward-always-indicate-ventricular-rhythm&amp;title=Question%3A%20%20Does%20an%20extreme%20right%20axis%20%28backward%29%20%20always%20indicate%20a%20ventricular%20rhythm%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, 22 Jan 2012 05:16:52 +0000 Dawn 166 at https://www.ecgguru.com https://www.ecgguru.com/expert-review/question-does-extreme-right-axis-backward-always-indicate-ventricular-rhythm#comments