tag:blogger.com,1999:blog-549949223388475481.post4181191547300616362..comments2024-03-18T03:32:48.613-05:00Comments on Dr. Smith's ECG Blog: What is the rhythm? And is there new left bundle branch block (LBBB)?Unknownnoreply@blogger.comBlogger10125tag:blogger.com,1999:blog-549949223388475481.post-37277221218713804502018-12-11T07:53:00.959-06:002018-12-11T07:53:00.959-06:00It is not upright. It is inverted because retrogr...It is not upright. It is inverted because retrograde, with VA conduction.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-66172337461503521322018-12-09T11:24:58.044-06:002018-12-09T11:24:58.044-06:00Thanks for the blog Dr. Smith. A great inspiration...Thanks for the blog Dr. Smith. A great inspiration to learn ECGs : ) and a favourite now world over.<br /><br />Dr. Smith, how do you figure that the P wave is upright in lead II ?? It could be inverted and produce the same curve in lead II if it came a touch earlier, couldn't it ?? Or it could be a markedly long 1st degree heart block since the disturbance in the ST segment has same morphology in I, II, aVF and V4-6 and inverted in aVR ?? Thanks in advance : )WADhttps://www.blogger.com/profile/03957968175594938614noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-16266423264816729492017-12-24T15:34:26.955-06:002017-12-24T15:34:26.955-06:00The above ECG record looks rather at the rhythm of...The above ECG record looks rather at the rhythm of the atrioventricular junction, carried out with the accompanying left bundle branch block - this is demonstrated by the retrograde P <100 ms wave for the QRS syndrome.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-78076110788706986892013-08-30T10:34:45.155-05:002013-08-30T10:34:45.155-05:00I can barely see the tracing as it is very blurry,...I can barely see the tracing as it is very blurry, but appears to me to be sinus with LBBB. Am I missing something?<br /><br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-22662734798763018612013-08-30T10:27:05.620-05:002013-08-30T10:27:05.620-05:00what about this ecg? https://dl.dropboxusercontent...what about this ecg? https://dl.dropboxusercontent.com/u/32778364/exact-moment--change-to-LBBB.jpgIgor Jovchevskihttps://www.blogger.com/profile/18020511766274463546noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-32627133126202841272012-05-28T12:14:37.212-05:002012-05-28T12:14:37.212-05:00Now that you mention it Dr. Smith, that reminds me...Now that you mention it Dr. Smith, that reminds me I've seen a similar case published in a textbook where the patient converts into atrial flutter from sinus rhythm and subsequently develops AIVR dissociated from the flutter. At this point, the only thing generating a pulse is the AIVR. Consequently, somebody was horrified enough by the appearance of the AIVR to administer a bolus of lidocaine. The ensuing result was ventricular asystole as the AIVR was completely suppressed. The only thing visualized on the baseline was the sawtooth pattern of the flutter waves and no sign of any ventricular activity. Therefore, no cardiac output and no pulse. <br /><br />1.) Conover MB. Understanding Electrocardiography. 7th ed. St. Louis: C.V. Mosby, 1996, p. 113 & 116.Jason E. Roediger, CCThttps://www.blogger.com/profile/12375233408457825429noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-30677356287928219482012-05-28T07:11:01.827-05:002012-05-28T07:11:01.827-05:00This is the normal discordant ST elevation in aVR ...This is the normal discordant ST elevation in aVR seen in LBBB morphology.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-32683242596238814992012-05-28T07:07:04.441-05:002012-05-28T07:07:04.441-05:00Semantically, you are correct. However, in usage ...Semantically, you are correct. However, in usage (which is usually considered the standard for correct language), AIVR is the name for an accelerated automatic rhythm of the ventricles. <br /><br />However, your point is important in that, if the rhtyhm did not conduct to the atria, it would imply AV block. This would make it much more dangerous if, for example, a clinician tried to treat to suppress the ventricle, then there would be no escape for the AV block and it may result in asystole.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-36547619862597171822012-05-27T23:19:55.530-05:002012-05-27T23:19:55.530-05:00I like your blog... thanks.
What do you think abo...I like your blog... thanks. <br />What do you think about ST change in aVr?<br />Was this meaningful or reciprocal?Anonymoushttps://www.blogger.com/profile/13813994831314266848noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-25881071542729291782012-05-27T20:59:52.156-05:002012-05-27T20:59:52.156-05:00Don’t mean to split hairs here, but I wanted to ma...Don’t mean to split hairs here, but I wanted to make a minor point on semantics of terminology. I would drop the prefix "idio" from this interpretation and fully spell out the rhythm as accelerated ventricular rhythm while forgoing the use of any non-standard acronym like AVR since it could be confused with lead aVR. Since there is 1:1 retrograde conduction to the atria, the ectopic ventricular focus has control over the entire heart as a whole. Not just the ventricles, but the atria as well.<br /><br />The prefix “idio-“ implies that the ventricles have their own pacemaker all to themselves and are beating independently of the atria (from the Greek, idios, which means “one’s own,” “private,” “personal”). (1)<br /><br />In leads V1 and V2, there are fat, little r-waves that are >0.03s wide. If you measure from the beginning of these r-waves to the nadir of the S-waves, that interval is delayed (i.e., late) at about 0.12s. Any duration >0.07s would strongly favor an ectopic ventricular focus. Dr. Wellens popularized this criteria and Dr. Marriott referred to it as the "Philadelphia clue". (2,3) <br />Reference/Source: <br />1.) Marriott HJL. Practical Electrocardiography. 8th ed. Baltimore: Williams & Wilkins, 1988, p. 277, 329, & 373.<br />2.) Marriott HJL. Marriott’s Manual in Electrocardiography. 1st ed. Naples: Trinity Press, 1999, p. 101<br />3.) http://heart.bmj.com/content/86/5/579.fullJason E. Roediger, CCThttps://www.blogger.com/profile/12375233408457825429noreply@blogger.com