tag:blogger.com,1999:blog-549949223388475481.post4241124853572621826..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: A 47-year-old man with abdominal pain and heart rates approaching 300 bpmUnknownnoreply@blogger.comBlogger13125tag:blogger.com,1999:blog-549949223388475481.post-82318359494348077022021-04-02T01:17:34.724-05:002021-04-02T01:17:34.724-05:00Amio also has AV nodal blocking propertiesAmio also has AV nodal blocking propertiesKarlhttps://www.blogger.com/profile/17705356298273442157noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-25505065600324641962021-03-27T10:36:14.544-05:002021-03-27T10:36:14.544-05:00If pulseless, unsynch. If pulses present, synchIf pulseless, unsynch. If pulses present, synchSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-34786355604591852502021-03-03T22:50:14.630-06:002021-03-03T22:50:14.630-06:00If i were to shock a polymorphic VT or AF with WPW...If i were to shock a polymorphic VT or AF with WPW, should it be synchronized, or unsynchronised ? Kenhttps://www.blogger.com/profile/17266588380020804028noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-65994133422976569022021-01-30T13:49:47.897-06:002021-01-30T13:49:47.897-06:00I think thats a great question. When you point it ...I think thats a great question. When you point it out, it does seem like parts of it are very close to regular. I can't say that I see definite flutter waves. But I think your theory is very possible. I'm not sure that I can definitely prove or disprove it. It certainly makes sense to go from flutter with intermittent conduction to deteriorate into AF. I am not sure, but thank you for bringing it up!Pendellhttps://www.blogger.com/profile/06506068475871794508noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-4729796163972041752021-01-19T09:41:32.841-06:002021-01-19T09:41:32.841-06:00This is probably a silly question. But could the 1...This is probably a silly question. But could the 1st ECG represent the patient coming in & out of AFL? Or having a AFL-AF degenerating and converting to each other intermittently? As Leads I & II appear to have some flutter wave at ~300bpm, and the RR intervals seem to be regularly irregular at either 1:1 (~300bpm) or 2:1 (~150bpm) conduction, whilst the QRS morphology may become polymorphic due to the accessory pathway being partially involved? And this also goes well with the clinical progress that the patient's rhythm might have completely degenerated into pre-excited AF subsequently as the 2nd ECG seems to have fairly irregular RR intervals.Anonymoushttps://www.blogger.com/profile/05315671855718045013noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-54725080426569944842021-01-16T10:28:20.638-06:002021-01-16T10:28:20.638-06:00Amiodarone is one of the least effective anti-dysr...Amiodarone is one of the least effective anti-dysrhythmics for atrial fib.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-59507846109276379572021-01-16T10:27:13.767-06:002021-01-16T10:27:13.767-06:00If there is absence of pre-excitation, the QRS wil...If there is absence of pre-excitation, the QRS will look normal. The accessary pathway is probably still refractory and there is no conduction down it.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-3257053509336360582021-01-16T02:38:19.326-06:002021-01-16T02:38:19.326-06:00excellent, as always Pendell. the ecg's are re...excellent, as always Pendell. the ecg's are remarkable; the last one with rates approaching 300 a bit scary.<br />thank you,once again.tfierohttps://www.blogger.com/profile/15955268501222734373noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-10677809991965024622021-01-15T16:36:12.302-06:002021-01-15T16:36:12.302-06:00Thnx for sharing this am interestinc about the cas...Thnx for sharing this am interestinc about the case . Med Lifehttps://www.blogger.com/profile/07714161617288924074noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-87794538135049708322021-01-15T07:41:34.914-06:002021-01-15T07:41:34.914-06:00Thanks! Unfortunately I do not have access to the ...Thanks! Unfortunately I do not have access to the original EP study, so I don't know where the pathway was or how many there were, or whether prior ablation had been attempted. <br /><br />Interesting about the case you describe above. I can imagine situations when the bypass tract is a bystander and thus adenosine reasonable. I think this would be difficult for us to know for sure in the ED, so I try to emphasize that adenosine is probably best avoided if the rhythm is polymorphic or irregular. <br /><br />Thanks Rehan!Pendellhttps://www.blogger.com/profile/01445330667624442976noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-23496618076040396262021-01-15T07:37:48.824-06:002021-01-15T07:37:48.824-06:00Here is a comment from one of our very helpful con...Here is a comment from one of our very helpful contributing electrophysiologists:<br /><br /><br />I was just curious about a few things (that might not be of much interest to your readers)…<br /><br />- Whether they found multiple accessory pathways vs single (if rates get too fast with pre-excited a-fib, that tends to happen with multiple accessory pathways more than single, and that tends to give “more” polymorphous appearance than this) – I would guess they found a single pathway rather than multiple.<br /><br />- Looking at the EKG, I would have expected location of the pathway to be more in posteroseptal region… so was curious where they found the pathway.<br /><br />On similar lines (ability to use adenosine or not), there was another recent case with pre-excitation where accessory pathway is a “bystander” and during SVT or even during A-fib, it is “okay” to give AV nodal blocking agents.<br /><br />Great case!<br /><br />Thanks,<br /><br />RehanPendellhttps://www.blogger.com/profile/01445330667624442976noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-7840521999360465122021-01-13T21:51:11.123-06:002021-01-13T21:51:11.123-06:00Sir..Thanks for your Guidances...I have a question...Sir..Thanks for your Guidances...I have a question. What’s the mechanism of normal looking qrs waves occurring occasionally in the initial ECG?.For a novice like me they may have been misinterpreted as capture beats Renju Binoyhttps://www.blogger.com/profile/01517465846998948366noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-22364744341949336982021-01-13T14:10:24.097-06:002021-01-13T14:10:24.097-06:00Why not give amiadarone here? Why not give amiadarone here? Anonymoushttps://www.blogger.com/profile/16264386623310374225noreply@blogger.com