tag:blogger.com,1999:blog-549949223388475481.post7913279836664432523..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Wide Complex Tachycardia. What is the Diagnosis? Unknownnoreply@blogger.comBlogger11125tag:blogger.com,1999:blog-549949223388475481.post-8331932180300227402017-03-06T19:25:31.918-06:002017-03-06T19:25:31.918-06:00Peter,
Very cool!
Thanks,
StevePeter,<br />Very cool!<br />Thanks,<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-14919816870361547092017-03-06T19:25:01.762-06:002017-03-06T19:25:01.762-06:00All good points, Ken. One correction: he never &qu...All good points, Ken. One correction: he never "converted", just slowed down. Same sinus rhythm on all EKGs.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-59727912983047024432017-03-05T19:03:19.373-06:002017-03-05T19:03:19.373-06:00I've been using that lead for over 40 years He... I've been using that lead for over 40 years Henry Marriott taught it to us. He always called it the S5 lead.Peter Bonadonnahttps://www.blogger.com/profile/07232149998955305580noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-15304382094099334102017-03-05T13:00:19.505-06:002017-03-05T13:00:19.505-06:00NICE case! In addition to RBBB/LAHB morphology — t...NICE case! In addition to RBBB/LAHB morphology — the rapid (ie, narrow) initial part of the QRS deflection in most leads on this tracing during the initial tachycardia support a supraventricular etiology — though as per Dr. Smith, one can’t completely rule out the possibility of posterior fascicular tachycardia based solely on the initial tracing. It almost looks like sinus P waves may be present at the end of what looks to be a long QT in each of the inferior leads. That said, lead V1 typically shows atrial activity when the rhythm is sinus — and such atrial activity is strangely absent from the initial 12-lead. Even with underlying (hidden) sinus P waves — the QT during the initial tachycardia looks prolonged, suggesting possible electrolyte imbalance (low K+/Mg++) as a possible contributing factor. Use of Lewis Leads is a excellent suggestion here. I was especially interested in the post-conversion 12-lead (done 24 hours later) — which still made me wonder why no atrial activity was seen in V1 on the initial tracing … That said, this is an excellent case illustrating the benefit of using Lewis Leads to help assess problematic arrhythmias.ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-38482843374408099192016-11-06T17:21:19.157-06:002016-11-06T17:21:19.157-06:00Adenosine causes sinus arrest, so P-waves disappea...Adenosine causes sinus arrest, so P-waves disappear with adenosine. Flutter waves do not.<br />Thank you for the kind words!<br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-78638340913068920782016-11-06T15:45:31.897-06:002016-11-06T15:45:31.897-06:00But why after the adenosine the p waves were not o...But why after the adenosine the p waves were not obvious? Also how do you explain the dominant R wave in aVR?I am bit confused.<br /><br />I am a big fan of your ecg blog. You have taught me so many things. Sincerely thank you sir!George Konstantinouhttps://www.blogger.com/profile/17537635350617697691noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-45461584593897838372016-05-17T13:38:03.000-05:002016-05-17T13:38:03.000-05:00Emre,
I got it from Christopher Watford: http://em...Emre,<br />I got it from Christopher Watford: http://emcrit.org/wee/lewis-lead/<br />I asked him where he got it from and here is his answer:<br /><br />"I learned the "S5" lead, which apparently was a Marriott choice from the original Lewis leads (perhaps an apocryphal story of Marriott's teaching, as I wasn't there). Lewis described a number of leads, the most popular of which is simply called the Lewis Lead where they're much closer together than the "S5 lead". Truly I have no clue why it is called the S5 lead."<br /><br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-27917720331966772862016-05-17T01:19:44.779-05:002016-05-17T01:19:44.779-05:00Dr. Smith,
Thanks for presenting this marvellous ...Dr. Smith,<br /><br />Thanks for presenting this marvellous case and reminding this precious tool. But, I am curious where does this definition of the Lewis lead come from. Is this a modification of the Lewis lead which had been shown to be better than the original definition ? I am not sure why Lewis lead is defined by the referenced page as described above, since Sir Thomas Lewis used this lead as <br /><br />Placed the Right Arm electrode on the 2nd intercostal space, right sternal border<br />Placed the Left Arm electrode on the 4th intercostal space, right sternal border<br />The Leg electrodes remained the same.<br />Monitored Lead I.<br /><br />The referenced page cites two papers, both of which used the original Lewis definition. I only find this placement in Wikipedia, which references Goldman's Principles of Clinical Electrocardiography 1982. <br /><br />Any comment for clarifying this issue would be really appreciated.<br /><br />Thanks in advance<br /><br />Emre Aslangernoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-2858404093495389462012-11-10T11:10:58.437-06:002012-11-10T11:10:58.437-06:00Koste,
See answer above.
Steve SmithKoste,<br />See answer above.<br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-7254506492376425422012-11-09T20:05:21.324-06:002012-11-09T20:05:21.324-06:00Interesting case Dr. Smith. Look like idiopathic f...Interesting case Dr. Smith. Look like idiopathic fascicular LV tachycardia to me. If this is tipical RBBB, could you explain or post some cases of atipical RBBB to make DD. thanks<br /><br />Kostehttps://www.blogger.com/profile/10080592850323840751noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-54775724143750022212012-11-09T14:57:37.409-06:002012-11-09T14:57:37.409-06:00Dr. Smith, the morphology of the qrs complex in V1...Dr. Smith, the morphology of the qrs complex in V1 (bbdx) and qrs in the inferior leads DII, DIII, aVF, with an axis deviated to the left (anterior fascicular block type) suggests a fascicular ventricular tachycardia (verapamil-sensitive)<br />It would have been proper and safe (obviously if the patient is unstable recourse to electrical cardioversion synchronized) administration of verapamil?<br />(drug classically avoided in wide complex tachycardia)<br />thanks<br />Vittorio MasciulliAnonymoushttps://www.blogger.com/profile/17960307225147640866noreply@blogger.com