tag:blogger.com,1999:blog-549949223388475481.post1383592061004340702..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: This middle-aged patient presented with SOB, weakness, and mild pulmonary edema.Unknownnoreply@blogger.comBlogger11125tag:blogger.com,1999:blog-549949223388475481.post-65260695915196827752020-01-29T04:08:02.224-06:002020-01-29T04:08:02.224-06:00very cool thoughts. thank you Steve and Kenvery cool thoughts. thank you Steve and Kentfierohttps://www.blogger.com/profile/15955268501222734373noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-48120870891629174242020-01-25T11:18:08.331-06:002020-01-25T11:18:08.331-06:00Thanks for the kind words. On occasion, AFib may “...Thanks for the kind words. On occasion, AFib may “organize” for a short period of time — and when it does, it may look like the atrial activity that you see in ECG #1 in leads V1 and V2. But this is NOT AFlutter because: i) consistently regular atrial activity is NOT seen; ii) the rate is FASTER than 1 large box in duration (ie, >300/minute) — which is not too fast to completely rule out flutter, but which makes flutter LESS likely; iii) there is a LOT of baseline ARTIFACT throughout the rest of this tracing — so it may well be that these deflections we see in V1 and V2 do not represent atrial activity at all; and iv) the ventricular rate is "off" for what I'd typically expect with AFlutter (usually there is 2:1 or 4:1 atrial activity). Otherwise — there is complete RBBB — which BY DEFINITION gives you an S wave in lead I. It also often gives you a q and T inversion in lead III. So in the absence of anything else in the history or this ECG that suggests pulmonary embolism — I do not ( = my personal preference) even mention an “S1Q3T3” in tracings like this in which there is complete RBBB — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-68758168304481998442020-01-25T06:38:28.124-06:002020-01-25T06:38:28.124-06:00Amazing post, thanks a lot.I would like to know if...Amazing post, thanks a lot.I would like to know if are there flutter waves in V1-V2, and the pattern S1Q3T3?O Poder da Eletrocardiografiahttps://www.blogger.com/profile/11143192155299060176noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-43888221147074676652020-01-24T22:01:06.213-06:002020-01-24T22:01:06.213-06:00Flo — Vielen Dank für dein Kommentar! (Many thanks...Flo — Vielen Dank für dein Kommentar! (Many thanks for your comment!). I don’t think Q waves in a ventricular paced rhythm are a reliable indicator of infarction (though the marked fragmentation that we do see in ECG #2 could be consistent with underlying “scar”). As I mentioned in My Comment (above) — I thought there were ECG indicators of ischemia in ECG #1 ( = my opinion). In any case — I thought more information than we are given would be needed to rule out ischemia as a potential contributing factor ( = my opinion).ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-21754924432075047912020-01-24T21:53:17.204-06:002020-01-24T21:53:17.204-06:00It's called dedication (the thought came to me...It's called dedication (the thought came to me ... ) — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-15915569430870878392020-01-23T18:06:42.080-06:002020-01-23T18:06:42.080-06:00You people don't sleep? Sitting in front of yo...You people don't sleep? Sitting in front of your desk top, putting notes at 2:25 AM, 6:41 AM.... ??<br />K.Anonymoushttps://www.blogger.com/profile/04509940285330859355noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-49903282880407724092020-01-23T11:43:40.662-06:002020-01-23T11:43:40.662-06:00Thank you very much for this amazing case and expl...Thank you very much for this amazing case and explanation.<br />I read that there was no evidence of ischemia but I wondered why there were so pronounced q waves in the second ecg in the anterior and inferior leads.<br />Is this all due to ventricular pacing?<br />Greetings from Germany.Flohttps://www.blogger.com/profile/05542654992758275535noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-60147005857197144632020-01-23T08:29:43.973-06:002020-01-23T08:29:43.973-06:00Just trying to piece together the sequence of what...Just trying to piece together the sequence of what happened when ... Atrial pacing is hemodynamically superior when there is sinus rhythm. The only other ECG in this case presumably showed AFib — so a good clinical point to be aware of, is that sinus rhythm should be reestablished prior to atrial pacing.ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-73688373959409763832020-01-23T06:41:40.972-06:002020-01-23T06:41:40.972-06:00I'm not sure what the point is (??)I'm not sure what the point is (??)Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-37572027315299205342020-01-23T02:25:54.802-06:002020-01-23T02:25:54.802-06:00Excellent point Max! This supports my quest for ad...Excellent point Max! This supports my quest for additional information and tracings regarding the time course and sequence of events that occurred BETWEEN the time that ECG #1 and ECG #2 was done. (P.S. I wrote My Comment [above] late yesterday — which may have been after the time that you submitted this question — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-55122922885920708892020-01-22T22:52:33.620-06:002020-01-22T22:52:33.620-06:00This is a dual chamber pacemaker, and afib require...This is a dual chamber pacemaker, and afib requires single chamber pacing. That means the rhythm conversion happened before device implantation.Max Romanchenkohttps://www.blogger.com/profile/17041087696138486491noreply@blogger.com