tag:blogger.com,1999:blog-549949223388475481.post3190510494956971128..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: New Onset Heart Failure and Frequent Prolonged SVT. What is it? Management?Unknownnoreply@blogger.comBlogger8125tag:blogger.com,1999:blog-549949223388475481.post-41131112332180903822021-01-30T12:47:31.415-06:002021-01-30T12:47:31.415-06:00No. Sorry.No. Sorry.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-29831091401546320802021-01-23T19:41:44.036-06:002021-01-23T19:41:44.036-06:00Very informative post. Any EP results yet ?Very informative post. Any EP results yet ?AKShttps://www.blogger.com/profile/02154650740617806061noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-57695906222002474662020-03-08T13:21:12.811-05:002020-03-08T13:21:12.811-05:00Thanks so much for the kind words Jerry (!) — and ...Thanks so much for the kind words Jerry (!) — and for your insights. I completely agree that for “all comers” who present with a regular SVT with suggestion of some atrial activity — ATach is statistically a lot more common than a “fast-slow” AVNRT. BUT — that is not what we are dealing with here. Rather than “all comers” with a regular SVT + suggestion of some atrial activity — ECG #3 (in my Figure-4) is a regular SVT with negative P waves (and to me, a characteristic upsloping shape to the ST segment leading up to those negative P waves) + a long RP’ interval — for which I think statistics favor a “fast-slow” AVNRT. And the PVC further reduces the likelihood that we are dealing with orthodromic AVRT. I could be wrong — and you could be right (!) — and our inability to know for certain until we have EP study results is what makes ECG interpretation so fascinating. THANKS (as always) for your comments Jerry! — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-90375665248973851012020-03-07T15:21:14.686-06:002020-03-07T15:21:14.686-06:00Ken...
What an excellent review! Thank you!
You ...Ken...<br /><br />What an excellent review! Thank you!<br /><br />You seemed surprised at the size of the retrograde P waves in the limb leads but I wasn't surprised at all. The P wave amplitude is not dependent on the location of the ectopic pacemaker but on the volume of the atrium and thickness of the myocardial atrial wall. What DID surprise me was the fact that with the reported biatrial enlargement, the P waves weren't any wider than they were. I would have expected some interatrial conduction delay.<br /><br />The differential diagnosis does appear to boil down to atrial tachycardia or a fast/slow AVNRT. However, I would go with atrial tachycardia strictly on a statistical basis. While it is the least frequent of the three main ectopic narrow-complex tachycardias (AVNRT, AVRT, AT), it is still a lot more common that a fast/slow AVNRT and a heck of a lot more common that a fast/slow AVNRT with a long R-P'. An orthodromic AVRT with a concealed, slowly conducting AP is another possibility, but - as you mentioned (and I agree) - this patient is not someone I would really suspect to have this. It DOES occur in adults, but is seen primarily in those who have just had surgery to correct a congenital heart defect. This patient had no such history.<br /><br />Thank you again for your diligence in reviewing previous posts and demonstrating the comparisons.Jerry W. Jones, MD FACEP FAAEMhttps://www.medicusofhouston.comnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-25334206714121636382020-03-06T23:11:22.876-06:002020-03-06T23:11:22.876-06:00Thanks K! — :)Thanks K! — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-63821890908017236432020-03-06T23:08:43.104-06:002020-03-06T23:08:43.104-06:00PJRT occurs predominantly in infants and children ...PJRT occurs predominantly in infants and children — and the patient here is a middle-aged adult ... That said — EP study will tell .. THANKS for your comment Subhasish — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-83304555694097768022020-03-06T20:19:40.068-06:002020-03-06T20:19:40.068-06:00A narrow qrs regular tachycardia, mostly asymptoma...A narrow qrs regular tachycardia, mostly asymptomatic, slightly faster than the sinus rate,negative p waves in II, III, AvF, rp>pr ,multiple spontaneous resolution and recurrence - PJRT. Subhasish Singh herehttps://www.blogger.com/profile/18022600313880536118noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-71337860764336863532020-03-06T19:41:41.076-06:002020-03-06T19:41:41.076-06:00Here, one could say "You think the negative d...Here, one could say "You think the negative deflection in front of the QRS of the ECG #3 above is an inverted P wave. I don't buy that". But the findings during the compensatory pause after a PVC proves that that is what it is as diagrammed in fig 4 above by Dr. Ken Grauer. Another example of "the usefulness of PVCs", one of my favorite ECG topics.<br />K. Wang.<br />Anonymoushttps://www.blogger.com/profile/04509940285330859355noreply@blogger.com