tag:blogger.com,1999:blog-549949223388475481.post7469540442159205440..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: A Southeast Asian with Tachycardia and Hypotension after taking a dangerous herbal medication (Bidirectional Ventricular Tachycardia from Aconite Poisoning)Unknownnoreply@blogger.comBlogger13125tag:blogger.com,1999:blog-549949223388475481.post-34232653716752345812017-05-04T13:11:11.512-05:002017-05-04T13:11:11.512-05:00Thanks a lot sir for the info ,Thanks a lot sir for the info ,Anonymoushttps://www.blogger.com/profile/06014453501248534334noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-88359236961673685672011-08-20T08:54:48.500-05:002011-08-20T08:54:48.500-05:00There is plenty of uncertainty in this arrhythmia....There is plenty of uncertainty in this arrhythmia. I don't think we have to worry about ischemia as the inciting cause, but of course the tachycardia could induce ischemia and we would be unlikely to see it on the ECG. Overdrive pacing often does not work. Here is a case in which beta blockers and amiodarone worked: http://drwes.blogspot.com/2011/08/ekg-du-jour-22-rare-classic.htmlSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-29263759927463540702011-08-20T00:32:15.226-05:002011-08-20T00:32:15.226-05:00I would be tempted to also give a temporary pacema...I would be tempted to also give a temporary pacemaker wire before giving something like flecainide in an unknown intoxication because you don't know what is underneath. Aconite can also cause bradycardia. Anyway, I would not give flec in such a case because of the long half time and because of the unknown diagnosis at that moment-fe structural heart disease? Ischemia?Chttps://www.blogger.com/profile/04928701846177343038noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-51493802091720326922011-08-05T18:16:09.843-05:002011-08-05T18:16:09.843-05:00It seems that's all a way of saying that, in t...It seems that's all a way of saying that, in this case, the rhythm is regular (unlike bigeminy).Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-54808630884844774852011-08-05T18:12:38.546-05:002011-08-05T18:12:38.546-05:00Dr. Smith,
To add in differentiation from bigemin...Dr. Smith,<br /><br />To add in differentiation from bigeminy, there is not the expected compensatory pause if these were PVCs, nor is there a resetting of the sinus rate if these were PACs/PJCs conducting aberrantly. This leaves bigeminal interpolated PVCs, but that just sounds crazy (if possible at all).<br /><br />Another differentiator would likely be palpable pulses with both styles of beats if this were bidirectional tachycardia versus bigeminal PVCs which wouldn't be likely to be perfusing.<br /><br />Granted, these are just observations as my experience with bidirectional tachycardia is limited to case reports (and now your blog)!Christopherhttps://www.blogger.com/profile/11415988855392944633noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-12586911264683349682011-08-05T17:11:50.770-05:002011-08-05T17:11:50.770-05:00Here you go: http://www.hospitalchronicles.gr/inde...Here you go: http://www.hospitalchronicles.gr/index.php/hchr/article/viewFile/242/366Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-26295550466602778962011-08-05T12:53:37.248-05:002011-08-05T12:53:37.248-05:00Could you possibly post a link to a website explai...Could you possibly post a link to a website explaining bidirectional tachycardia in a little bit more detail? I'm having a little trouble grasping the concept of it, thank you!medicstrydorhttps://www.blogger.com/profile/09534688293855372435noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-85165362518616512812011-08-05T11:13:30.045-05:002011-08-05T11:13:30.045-05:00Bigeminy is always irregular, with the PVC coming ...Bigeminy is always irregular, with the PVC coming early, resulting in "grouped" beating. In this case, every R-R interval is exactly the same. This is also true of atrial bigeminy. If there were p-waves in front of each complex, then it would be alternating RBBB and LBBB. But there are no p-waves. This is automaticity alternating from right to left. Then the question is this: could bidirectional tachycardia be grouped, and I have to say I don't know the answer, but I suspect that, because there could be differing rates of automaticity in the right and left ventricles, that it is likely.<br /><br />Any comments on this?<br /><br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-88615984603696976372011-08-05T07:34:34.912-05:002011-08-05T07:34:34.912-05:00what about such things as, say, underlying junctio...what about such things as, say, underlying junctional rhythm with bigeminy without P waves? can those occur? if so, how does one tell those apart from bi-directional VT?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-14961969948043214272011-08-05T05:53:23.697-05:002011-08-05T05:53:23.697-05:00Don't worry, its a good question! Bigeminy ha...Don't worry, its a good question! Bigeminy has a sinus beat followed the PVC, so one of the beats has to be preceded by a p-wave.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-67454962381415204742011-08-05T01:20:40.438-05:002011-08-05T01:20:40.438-05:00doc,
looking at this particular tracing, how does...doc,<br /><br />looking at this particular tracing, how does one differentiate between bidirectional VT and an underlying BBB (or even an underlying non-BBB) with some sort of bigeminy?<br /><br />or have we been too careless in identifying bigeminy, and instead should be more suspicious of something like bidirectional VT?<br /><br />(i can't get the question to not sound stupid.)<br /><br />thanks.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-61631330399804478712011-08-04T17:09:23.228-05:002011-08-04T17:09:23.228-05:00Little data, but a 1c (Flecainide) is a better sod...Little data, but a 1c (Flecainide) is a better sodium channel blocker than the 1a's, and does not delay repolarization as the 1a's do. Best I can tell you.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-54578692977999651822011-08-04T16:53:39.946-05:002011-08-04T16:53:39.946-05:00Would a Ia like procainamide be effective, or are ...Would a Ia like procainamide be effective, or are Ic's required in digitalis induced bidirectional tachycardia?Christopherhttps://www.blogger.com/profile/11415988855392944633noreply@blogger.com