tag:blogger.com,1999:blog-11990604162027454082024-03-19T13:40:15.296+08:00ECG of the WeekA weekly ECG / EKG review blog looking at some interesting ECG's from the world of Emergency Medicine.
<a href="http://twitter.com/search?q=%23FOAMed">#FOAMed Supporter </a> Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.comBlogger741125tag:blogger.com,1999:blog-1199060416202745408.post-28820906116539096572019-03-05T08:22:00.004+08:002019-03-05T08:22:53.879+08:00Thank You<span style="font-family: Arial, Helvetica, sans-serif;">ECG of the Week started just over 7 years ago now, in that time we've reviewed over 360 cases, had over 980,000 page views and managed to gather an international readership. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">I now want to focus on other education, professional and personal projects and this will be the last post on this site.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">I'm very pleased to say there is a new team of ECG enthusiasts ready to take over from me and they will be continuing to post weekly interesting ECG cases over at <strong><a href="http://www.emergucate.com/" target="_blank">Emergucate</a></strong>.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">I'd like to thank all our readers, commenters, contributors, authors and the great on-line ECG community for their continued commitment to ECG education.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Thank you,</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">John Larkin</span>Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com8tag:blogger.com,1999:blog-1199060416202745408.post-21281208212494595722019-02-27T13:30:00.000+08:002019-02-27T13:30:03.124+08:00ECG of the Week - 25th February 2019 - Interpretation<span style="font-family: "arial" , "helvetica" , sans-serif;">The following ECG is from a 75 yr old male who presented hypotensive and febrile with suspected intra-abdominal sepsis.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHtJRPl39Ly5IA6AvP66O7Lw-PzneiWpBibItdKWXy94eoiI2fFtj6bo9PypdgYM6gUSCNXoqQGira-xmYqEzrUCofZ5zL56iyV3eEcmL8Xb1Ns5ajVYG_PYEH7sv9Cz8e_2dvZVPCl2Kd/s1600/ECG477.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><img border="0" data-original-height="840" data-original-width="1600" height="168" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHtJRPl39Ly5IA6AvP66O7Lw-PzneiWpBibItdKWXy94eoiI2fFtj6bo9PypdgYM6gUSCNXoqQGira-xmYqEzrUCofZ5zL56iyV3eEcmL8Xb1Ns5ajVYG_PYEH7sv9Cz8e_2dvZVPCl2Kd/s320/ECG477.jpg" width="320" /></span></a></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;">Rate:</span></span><ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">78 bpm</span></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Rhythm:</span></span><div>
</div>
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Complexes #1-3 & #7-12</span></span></li>
<ul>
<li>Sinus rhythm</li>
</ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Complexes #4-6</span></span></li>
<ul>
<li>PVC</li>
<li>Different morphology than sinus complexes</li>
<li>QRS widening</li>
</ul>
</ul>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Axis:</span></span><ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Normal </span></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Intervals - sinus complexes:</span></span><ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">PR - Normal</span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">QRS - Normal</span></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Additional:</span></span></span><ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>Start of ECG missing</span></span></span></span></li>
<li>ST Depression V1-2</li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">ST Elevation leads II, III, V4-6</span></span></span></li>
<ul>
<li>Not typically seen morphology</li>
</ul>
<li>Baseline wander ? contributing to ST abnormality</li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Discordant ST changes in PVCs</span></span></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><strong>ST Morphology</strong></span><br />
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Unfortunately I don't have more information of this case in terms of clinical closure.<br />
The ST morphology is unusual and certainly not commonly seen there are a few potential differentiations for this morphology emerging in the literature:<br />
<ul>
<li>Could it be due to artefact - the morphology o the STE does seem to vary beat to beat</li>
<li>Give the morphology a name - there a several examples and case reports of similar morphologies associated with differing clinical scenarios</li>
<ul>
<li>'Shark Fin' STE - <a href="http://hqmeded-ecg.blogspot.com/2018/06/shark-fin-deadly-ecg-sign-that-you-must.html">Dr Smith's ECG Blog Case</a> - Associated with acute coronary artery occlusion.</li>
<li>'Lambda wave' may be a predictor of VF risk in AMI - <a href="https://www.semanticscholar.org/paper/Characteristics-of-electrocardiographic-in-acute-by-Aizawa-Jastrz%C4%99bski/e875d9cabf17a8e73bbc8be514db66f302c18944">Article 1</a> , <a href="https://pdfs.semanticscholar.org/396e/2e57b5fabe5bd4b4a1d988a80174ec7e8d4e.pdf">Article 2</a></li>
<li>'Lambda wave' also be associated with takotsubo cardiomyopathy and may confer a worse prognosis - <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/anec.12581">Article 3</a></li>
</ul>
</ul>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><strong>References / Further Reading</strong></span></span><div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"> </span></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial";"><span style="font-family: "arial" , "helvetica" , sans-serif;">Textbook</span></span></span><div>
</div>
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">C<span style="font-family: "arial" , "helvetica" , sans-serif;">han TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.</span><span style="font-family: "times new roman";"> </span></span></span></li>
</ul>
<br />Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com4tag:blogger.com,1999:blog-1199060416202745408.post-23249310350665499832019-02-22T08:30:00.000+08:002019-02-22T08:30:11.439+08:00ECG of the Week - 25th February 2019<span style="font-family: Arial, Helvetica, sans-serif;">The following ECG is from a 75 yr old male who presented hypotensive and febrile with suspected intra-abdominal sepsis.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHtJRPl39Ly5IA6AvP66O7Lw-PzneiWpBibItdKWXy94eoiI2fFtj6bo9PypdgYM6gUSCNXoqQGira-xmYqEzrUCofZ5zL56iyV3eEcmL8Xb1Ns5ajVYG_PYEH7sv9Cz8e_2dvZVPCl2Kd/s1600/ECG477.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" data-original-height="840" data-original-width="1600" height="168" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHtJRPl39Ly5IA6AvP66O7Lw-PzneiWpBibItdKWXy94eoiI2fFtj6bo9PypdgYM6gUSCNXoqQGira-xmYqEzrUCofZ5zL56iyV3eEcmL8Xb1Ns5ajVYG_PYEH7sv9Cz8e_2dvZVPCl2Kd/s320/ECG477.jpg" width="320" /></span></a></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">Things to think about</span></b><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What are the key ECG features ?</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What is the potential cause for these features ?</span></li>
</ul>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com1tag:blogger.com,1999:blog-1199060416202745408.post-91446761118315105252019-02-20T13:30:00.000+08:002019-02-20T13:30:05.560+08:00ECG of the Week - 18th February 2019 - Interpretation<span style="font-family: "arial" , "helvetica" , sans-serif;">The following ECG is from a 65yr old male who presented following a large dothiepin overdose.</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjlKN4BSgnDoQXpYKCqnykD_qjXs4TRBfSbgQdpplf42txM6imAgErMDjh-6agesy_hdynKtrRKzVoDmJkE8YKYv7dw5uYWXhbwwUQjqWBNeWjen1MEXrqhbpFu2R_AqsH-33h_uIDx3Yl1/s1600/ECG476.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><img border="0" data-original-height="804" data-original-width="1600" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjlKN4BSgnDoQXpYKCqnykD_qjXs4TRBfSbgQdpplf42txM6imAgErMDjh-6agesy_hdynKtrRKzVoDmJkE8YKYv7dw5uYWXhbwwUQjqWBNeWjen1MEXrqhbpFu2R_AqsH-33h_uIDx3Yl1/s400/ECG476.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: small;">Click to enlarge</span></td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;">Rate:<span style="font-family: "arial" , "helvetica" , sans-serif;"> </span></span></span></span></span></div>
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">90 bpm</span></span></span></span></span></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Rhythm:</span></span><br />
<div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"> </span></div>
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;"> </span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Regular</span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Sinus rhythm </span> </span></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Axis:<span style="font-family: "arial" , "helvetica" , sans-serif;"> </span></span></span><br />
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Normal</span> </span></span></span></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Intervals:</span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></span><br />
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;"> </span><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">PR - Normal <span style="font-size: xx-small;">(~200ms)</span></span> </span></span></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">QRS - Prolonged <span style="font-size: xx-small;">(~140ms)</span></span> </span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">QT - 400ms <span style="font-size: xx-small;">(QTc Bazette 490 ms)</span></span> </span></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Additional:</span></span><br />
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;">Terminal R wave in lead aVR ~4mm</span></span></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">T wave inversion lead II<span style="font-family: "arial" , "helvetica" , sans-serif;">I</span></span></span></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Variable P wave morphology - ? secondary artefact vs conduction abnormality</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Baseline artefact in rhythm strip</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">RBBB Morphology</span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><br />
<div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"> I<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">nterpretation:</span></span></span></span></span></div>
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">ECG features consistent with TCA overdose and sodium channel toxicity</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">QRS Prolongation</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Terminal R wave in lead aVR</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">RBBB Morphology</span></li>
</ul>
<div>
<div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"> </span></div>
</div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><br />
<div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"> <span style="font-family: "arial" , "helvetica" , sans-serif;"><strong>What happened ?</strong></span></span></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><br />
<div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"> </span></div>
<div>
<span style="font-family: "arial" , "helvetica" , sans-serif;">The patient underwent the following treatment:</span></div>
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">IV Sodium bicarbonate</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">RSI</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Post intubation hyperventilation</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">NGT and charcoal</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Serial cardiac monitoring</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Exclusion of other co-ingestions</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Admitted to ICU for ongoing care</span></li>
</ul>
<div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"> </span></div>
<div>
<strong><span style="font-family: "arial" , "helvetica" , sans-serif;">ECG Features and Management of TCA Toxicity</span></strong></div>
<div>
<div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"> </span></div>
</div>
<div>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Check out the following posts from </span><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Life in the Fast Lane for more information:</span></span><ul><span style="font-family: "arial" , "helvetica" , sans-serif;">
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><a href="http://lifeinthefastlane.com/ecg-library/basics/tca-overdose/" target="_blank">Sodium Channel Blocker Toxicity</a></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><a href="http://lifeinthefastlane.com/toxicology-conundrum-050/" target="_blank">Toxicology Conundrum - Another TCA overdose</a></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><a href="http://lifeinthefastlane.com/toxicology-conundrum-022/" target="_blank">Toxicology Conundrum - TCA Toxicity</a></span></li>
</span></ul>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"> </span></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><strong>References / Further Reading</strong></span></span><div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial";"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span></span></span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"> </span></span></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;">
</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial";"><span style="font-family: "arial" , "helvetica" , sans-serif;">Textbook</span></span></span><br />
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial";"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">C<span style="font-family: "arial" , "helvetica" , sans-serif;">han TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.</span><span style="font-family: "times new roman";"> </span></span></span></span></span></span></span></li>
</ul>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com0tag:blogger.com,1999:blog-1199060416202745408.post-23144406336024223252019-02-15T12:49:00.002+08:002019-02-15T12:49:26.799+08:00ECG of the Week - 18th February 2019<span style="font-family: Arial, Helvetica, sans-serif;">The following ECG is from a 65yr old male who presented following a large dothiepin overdose.</span><br />
<br />
<a name='more'></a><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjlKN4BSgnDoQXpYKCqnykD_qjXs4TRBfSbgQdpplf42txM6imAgErMDjh-6agesy_hdynKtrRKzVoDmJkE8YKYv7dw5uYWXhbwwUQjqWBNeWjen1MEXrqhbpFu2R_AqsH-33h_uIDx3Yl1/s1600/ECG476.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" data-original-height="804" data-original-width="1600" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjlKN4BSgnDoQXpYKCqnykD_qjXs4TRBfSbgQdpplf42txM6imAgErMDjh-6agesy_hdynKtrRKzVoDmJkE8YKYv7dw5uYWXhbwwUQjqWBNeWjen1MEXrqhbpFu2R_AqsH-33h_uIDx3Yl1/s400/ECG476.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Click to enlarge</span></td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>Things to think about</b></span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What are the key ECG features ?</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What are the key ECG features associated with a dothiepin overdose ?</span></li>
</ul>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com0tag:blogger.com,1999:blog-1199060416202745408.post-68865988897992764212019-02-13T13:30:00.000+08:002019-02-13T13:30:09.540+08:00ECG of the Week - 11th February 2019 - Interpretation<span style="font-family: "arial" , "helvetica" , sans-serif;">The following ECG is from a 70 year old female who was referred by her GP following an episode of chest pain.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><br />
<a name='more'></a><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjb3ZVlTxvWxzdWMS695ZnWe1KhSACBpDVu-b_ms7r82vIAyeXFUvTWGGMWnM-htJxVsojin1PqcuazYuHfNxqn5Ykfttv8xwUrmHqSpRV1VAqgFmLhhijaEP-1tek3SOIld1tjoYHGZ7Aj/s1600/ECG475.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><img border="0" data-original-height="782" data-original-width="1508" height="206" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjb3ZVlTxvWxzdWMS695ZnWe1KhSACBpDVu-b_ms7r82vIAyeXFUvTWGGMWnM-htJxVsojin1PqcuazYuHfNxqn5Ykfttv8xwUrmHqSpRV1VAqgFmLhhijaEP-1tek3SOIld1tjoYHGZ7Aj/s400/ECG475.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Click to enlarge</span></td></tr>
</tbody></table>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><div>
<br /><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;">Rate:</span></span></span></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span> </div>
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">72 bpm</span></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Rhythm:</span></span><div>
</div>
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Regular</span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Sinus rhythm </span> </span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Axis:</span></span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Normal <span style="font-size: xx-small;">(-30 deg)</span></span> </span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Intervals:</span></span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">PR - Normal <span style="font-size: xx-small;">(~160ms)</span></span> </span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">QRS - Normal <span style="font-size: xx-small;">(100ms)</span></span> </span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Additional:</span></span><br />
<ul>
<li>Flat lead II - near isoelectric</li>
<li>Complete reversal leads III, aVF</li>
<ul>
<li>T inversion</li>
<li>Negative QRS </li>
<li>Negative P waves - low voltage</li>
</ul>
<li>Prominent T wave lead V2</li>
<li>ST depression leads V5-6</li>
</ul>
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Interpretation:</span></span><br />
<ul>
<li>Multiple abnormalities in limb leads</li>
<ul>
<li>Secondary to complex lead reversal - not typical of paired lead swap</li>
</ul>
<li>Prominent T wave in lead V2 with ST depression in lateral leads </li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><strong>What happened ?</strong></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">A repeat ECG with correct lead position resulted in resolution of all limb lead abnormalities and unchanged non-dynamic precordial lead changes.</span>Serial cardiac biomarkers were negative and the patient was discharge.<div>
</div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><strong>References / Further Reading</strong></span></span><div>
</div>
<div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Life in the Fast Lane</span></span></div>
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><a href="https://litfl.com/ecg-limb-lead-reversal-ecg-library/" target="_blank">Lead reversal</a></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial";"><span style="font-family: "arial" , "helvetica" , sans-serif;">Textbook</span></span></span><ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">C<span style="font-family: "arial" , "helvetica" , sans-serif;">han TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.</span></span></span></li>
</ul>
</span></span><br />
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com3tag:blogger.com,1999:blog-1199060416202745408.post-57391049205945194812019-02-08T08:30:00.000+08:002019-02-08T08:30:13.456+08:00ECG of the Week - 11th February 2019<span style="font-family: Arial, Helvetica, sans-serif;">The following ECG is from a 70 year old female who was referred by her GP following an episode of chest pain.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<a name='more'></a><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjb3ZVlTxvWxzdWMS695ZnWe1KhSACBpDVu-b_ms7r82vIAyeXFUvTWGGMWnM-htJxVsojin1PqcuazYuHfNxqn5Ykfttv8xwUrmHqSpRV1VAqgFmLhhijaEP-1tek3SOIld1tjoYHGZ7Aj/s1600/ECG475.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" data-original-height="782" data-original-width="1508" height="206" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjb3ZVlTxvWxzdWMS695ZnWe1KhSACBpDVu-b_ms7r82vIAyeXFUvTWGGMWnM-htJxVsojin1PqcuazYuHfNxqn5Ykfttv8xwUrmHqSpRV1VAqgFmLhhijaEP-1tek3SOIld1tjoYHGZ7Aj/s400/ECG475.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Click to enlarge</span></td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>Things to think about</b></span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What are the key ECG features ?</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What are the differentials for these features ?</span></li>
</ul>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com4tag:blogger.com,1999:blog-1199060416202745408.post-66714972473705095602019-02-06T13:30:00.000+08:002019-02-06T13:30:02.805+08:00ECG of the Week - 4th February 2019 - Interpretation<span style="font-family: "arial" , "helvetica" , sans-serif;">The following ECG is from a 75 yr old male with a history of cardiomyopathy. He presented to the ED following shock delivery from his AICD. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><br />
<a name='more'></a><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWo7TybTWEydRhRAQ6KrNr5FXV3uViZIxHSkkdltvEFGZsKHeXZJOPYNRyXPaHUy-HAxFpHMqMPWFaVEx5g8lff6W2cqIMNongLmZQKB6OXizRkJIBsL-5ngYxkgJjEuedurHAHNIfNKwi/s1600/ECG474.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><img border="0" data-original-height="867" data-original-width="1600" height="216" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWo7TybTWEydRhRAQ6KrNr5FXV3uViZIxHSkkdltvEFGZsKHeXZJOPYNRyXPaHUy-HAxFpHMqMPWFaVEx5g8lff6W2cqIMNongLmZQKB6OXizRkJIBsL-5ngYxkgJjEuedurHAHNIfNKwi/s400/ECG474.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: small;">Click to enlarge</span></td></tr>
</tbody></table>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: arial, helvetica, sans-serif;">ECG features:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Initial ~3750ms of the ECG shows</span></li>
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Wide complex tachycardia</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Rate 195-200 bpm</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">No fusion or capture</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Variable noting in terminal QRS - ? atrial activity</span></li>
</ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Initiation of anti-tachycardia pacing</span></li>
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Series of 5 pacing spikes</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Reducing cycle length</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Capture with variable QRS morphology</span></li>
</ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Cessation of wide complex tachycardia</span></li>
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">800ms Pause</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">1 Native QRS complex</span></li>
</ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Recurrence of wide complex tachycardia</span></li>
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Same morphology as initial rhythm on ECG</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">No fusion or capture</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Not typical BBB morphology</span></li>
</ul>
</ul>
<br />
<span style="font-family: arial, helvetica, sans-serif;">Interpretation:</span><br />
<span style="font-family: Arial;">
<ul>
<li style="font-family: arial;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Wide complex tachycardia</span></li>
<ul>
<li><span style="font-family: arial, helvetica, sans-serif;">Monomorphic VT</span></li>
</ul>
<li style="font-family: arial;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Termination by anti-tachycardia pacing (ATP)</span></li>
<li style="font-family: arial;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Recurrence of broad complex tachycardia</span></li>
</ul>
<span style="font-family: arial;"></span><div style="font-family: arial;">
<b>Anti-tachycardia Pacing (ATP)</b><br />
<br />
This is a pacing mode found in AICDs which uses pacing delivery in an attempt to interrupt a re-entry circuit tachycardia. The advantage of ATP over shock delivery is that it prevents patient discomfort and prolonged battery life by minimizing need for shock delivery. ATP is ineffective for PMVT and VF; ATP delivery to monomorphic VT can result in acceleration and degeneration to PMVT or VF both of which will necessitate shock delivery to terminate.<br />
Further information and some more examples can be found in the articles / posts below.<br />
</div>
<div style="font-family: arial;">
<span style="font-family: arial, helvetica, sans-serif;">Case example from ECG Guru.com</span></div>
<ul style="font-family: arial;">
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><a href="https://ecgguru.com/ecg/anti-tachycardia-function-icd" target="_blank">Anti-tachycardia Function of ICD</a></span></li>
</ul>
<span style="font-family: arial;">
Articles</span><br />
<ul style="font-family: arial;">
<li><a href="https://www.medtronicacademy.com/features/ventricular-antitachycardia-pacing-feature" target="_blank">Medtronic Academy</a></li>
<li><a href="https://www.medscape.com/viewarticle/490543" target="_blank">Medscape Review (log-in required)</a></li>
<li><a href="https://www.ajconline.org/article/S0002-9149(96)00508-5/pdf" target="_blank">Rosenqvist M. Antitachycardia Pacing: Which Patients and Which Methods? (Am J Cardiol 1996;78(supp5lA):92-97) - An older paper but covers some of the basics and freely available</a></li>
<span style="font-family: "arial";"><br /></span></ul>
</span>Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com4tag:blogger.com,1999:blog-1199060416202745408.post-39792881214646424982019-02-01T14:44:00.000+08:002019-02-01T14:44:00.752+08:00ECG of the Week - 4th February 2019<span style="font-family: Arial, Helvetica, sans-serif;">The following ECG is from a 75 yr old male with a histroy of cardiomyopathy. He presented to the ED following shock delivery from his AICD. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<a name='more'></a><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWo7TybTWEydRhRAQ6KrNr5FXV3uViZIxHSkkdltvEFGZsKHeXZJOPYNRyXPaHUy-HAxFpHMqMPWFaVEx5g8lff6W2cqIMNongLmZQKB6OXizRkJIBsL-5ngYxkgJjEuedurHAHNIfNKwi/s1600/ECG474.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" data-original-height="867" data-original-width="1600" height="216" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWo7TybTWEydRhRAQ6KrNr5FXV3uViZIxHSkkdltvEFGZsKHeXZJOPYNRyXPaHUy-HAxFpHMqMPWFaVEx5g8lff6W2cqIMNongLmZQKB6OXizRkJIBsL-5ngYxkgJjEuedurHAHNIfNKwi/s400/ECG474.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Click to enlarge</span></td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>Things to think about</b></span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What are the key ECG findings ?</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Is the AICD functioning appropriately ?</span></li>
</ul>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com0tag:blogger.com,1999:blog-1199060416202745408.post-40884912856669606252019-01-30T13:30:00.000+08:002019-01-30T13:30:02.158+08:00ECG of the Week - 28th January 2019 - Interpretation<span style="font-family: "arial" , "helvetica" , sans-serif;">The following ECG is from an 18 yr old female who presents with ongoing weight loss with a known eating disorder. Her weight is 33 kg (72 lbs) with a BMI of ~13.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><br />
<a name='more'></a><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGlhpcxcHHW3vnwG-b45yDfB36sIq0ZFqByui-lLLPgO_4l89Om7gdLUbjzgw2gXT4UDWXX1E1tSGDxThm1mytS6SDRBRzz7FwKWcT4k2u-zjSaK5LKAjJnX-3Bg-DZzLSojdyTGWMv7fA/s1600/ECG473.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><img border="0" data-original-height="765" data-original-width="1600" height="191" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGlhpcxcHHW3vnwG-b45yDfB36sIq0ZFqByui-lLLPgO_4l89Om7gdLUbjzgw2gXT4UDWXX1E1tSGDxThm1mytS6SDRBRzz7FwKWcT4k2u-zjSaK5LKAjJnX-3Bg-DZzLSojdyTGWMv7fA/s400/ECG473.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: small;">Click to enlarge</span></td></tr>
</tbody></table>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;">Rate:</span><br />
<div>
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: arial, helvetica, sans-serif;">36 bpm</span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Rhythm:</span></span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Sinus rhythm</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Sinus arrhythmia</span></li>
</ul>
<span style="font-family: arial, helvetica, sans-serif;">Axis:</span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Inferior<span style="font-size: xx-small;"> </span></span></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Intervals:</span></span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">PR - Normal <span style="font-size: xx-small;">(~170ms)</span></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">QRS - Normal <span style="font-size: xx-small;">(100ms)</span></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">QT - 490ms </span></span></li>
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;">QTc Bazett 380ms</span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">QTc Hodges 450ms</span></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;">QTc Framingham 290ms</span></span></li>
</ul>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;">Additional:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">T inversion aVL with negative QRS</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">T wave inversion leads V1-2</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">No ST depression</span></li>
</ul>
<br />
<span style="font-family: arial, helvetica, sans-serif;">Interpretation:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Significant sinus bradycardia</span></li>
</ul>
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: arial, helvetica, sans-serif;"><b>ECG and Cardiac Abnormalities associated with eating disorders</b></span><br />
<span style="font-family: arial, helvetica, sans-serif;"><br /></span>
<span style="font-family: arial, helvetica, sans-serif;">ECG and cardiac abnormalities </span><span style="font-family: arial, helvetica, sans-serif;">associated with eating disorders can be multi-factorial and related to:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Loss of cardiac muscle - cardiac failure, mitral valve prolapse</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Electrolyte abnormalities - hypokalaemia, hypomagnesaemia</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Chronic nutritional deficit - cardiomyopathy</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Parasympathetic overdrive - bradycardia, hypotension</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Dehydration / volume depletion - hypotension</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Medication use / abuse - laxatives, sympathomimetics, anti-depressants, anti-psychotics</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Secondary to treatment - re-feeding syndrome, electolyte abnormalities</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">ECG features are secondary to the issues listed above and include:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">QT / QTc prolongation with associated risk of TdP and Sudden cardiac death</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Severe bradycardia</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">AV block</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">T wave abnormalities - usually associated with electrolyte abnormality</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Low voltage</span></li>
</ul>
<br />
<span style="font-family: arial, helvetica, sans-serif;">Mainstay of treatment is correction of electrolyte abnormality and encourage nutritional intake and weight gain whilst monitoring for re-feeding issues.</span><br />
<span style="font-family: arial, helvetica, sans-serif;"><br /></span>
<strong style="font-family: arial, helvetica, sans-serif;">References / Further Reading</strong><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /><span style="font-family: "arial" , "helvetica" , sans-serif;">Life in the Fast Lane</span></span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><a href="https://litfl.com/hypokalaemia-ecg-library/" target="_blank">Hypokalaemia</a></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><a href="https://litfl.com/qt-interval-ecg-library/" target="_blank">QT Interval / QT Prolongation</a></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial";"><span style="font-family: "arial" , "helvetica" , sans-serif;">Textbook</span></span></span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">C<span style="font-family: "arial" , "helvetica" , sans-serif;">han TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.</span></span></span></li>
</ul>
</div>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com0tag:blogger.com,1999:blog-1199060416202745408.post-16735105733268040092019-01-25T08:00:00.000+08:002019-01-25T08:00:07.463+08:00ECG of the Week - 28th January 2019<span style="font-family: Arial, Helvetica, sans-serif;">The following ECG is from an 18 yr old female who presents with ongoing weight loss with a known eating disorder. Her weight is 33 kg (72 lbs) with a BMI of ~13.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<a name='more'></a><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGlhpcxcHHW3vnwG-b45yDfB36sIq0ZFqByui-lLLPgO_4l89Om7gdLUbjzgw2gXT4UDWXX1E1tSGDxThm1mytS6SDRBRzz7FwKWcT4k2u-zjSaK5LKAjJnX-3Bg-DZzLSojdyTGWMv7fA/s1600/ECG473.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" data-original-height="765" data-original-width="1600" height="191" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGlhpcxcHHW3vnwG-b45yDfB36sIq0ZFqByui-lLLPgO_4l89Om7gdLUbjzgw2gXT4UDWXX1E1tSGDxThm1mytS6SDRBRzz7FwKWcT4k2u-zjSaK5LKAjJnX-3Bg-DZzLSojdyTGWMv7fA/s400/ECG473.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Click to enlarge</span></td></tr>
</tbody></table>
<b style="font-family: Arial, Helvetica, sans-serif;">Things to think about</b><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What are the key ECG features ?</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What ECG abnormalities are associated with eating disorders ?</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What cardiac complications are associated with eating disorders ?</span></li>
</ul>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com0tag:blogger.com,1999:blog-1199060416202745408.post-70849311699228609122019-01-23T13:30:00.000+08:002019-01-23T13:30:06.264+08:00ECG of the Week - 21st January 2019 - Interpretation<span style="font-family: Arial, Helvetica, sans-serif;">The following ECG is from a 34 year old female who presented with palpitations and dysponea.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<a name='more'></a><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
</span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyjMnemOAtn9Dmtup9e7V9axoEKi7DmOlAMUKQvBclM-0Ld_250EVX5Lr04_Vc5FQ94X6ibzZrVgNIX1sE1YIhGYQEQdRJcPIvT6V084WUCI8sBGc-I4Wdt_hyphenhyphenJgZhJ2fkizHmiebw6TOX/s1600/ECG472.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" data-original-height="788" data-original-width="1600" height="196" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyjMnemOAtn9Dmtup9e7V9axoEKi7DmOlAMUKQvBclM-0Ld_250EVX5Lr04_Vc5FQ94X6ibzZrVgNIX1sE1YIhGYQEQdRJcPIvT6V084WUCI8sBGc-I4Wdt_hyphenhyphenJgZhJ2fkizHmiebw6TOX/s400/ECG472.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;"><span style="font-family: Arial, Helvetica, sans-serif;">Click to enlarge</span></td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif;">Rate:</span><br />
<div>
<ul><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
</span>
<li><span style="font-family: Arial, Helvetica, sans-serif;">132 bpm</span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;">Rhythm:</span></span><br />
<ul><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
</span>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Regular</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">AV dissociation</span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;">Axis:</span></span><br />
<ul><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
</span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;">Inferior</span></span></li>
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;">Near isoelectric lead I with positive lead aVF</span></span></li>
</ul>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;">Intervals:</span></span><br />
<ul><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
</span>
<li><span style="font-family: Arial, Helvetica, sans-serif;">QRS - Prolonged</span></li>
</ul>
<span style="font-family: Arial, Helvetica, sans-serif;">Additional:</span><br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">LBBB Morphology</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Nil capture beats</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Nil fusion beats</span></li>
</ul>
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;">Interpretation:</span></span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Wide complex tachycardia</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">LBBB Morphology with inferior axis and features supportive of VT (AV dissociation)</span></li>
</ul>
<span style="font-family: Arial, Helvetica, sans-serif;">What happened ?</span><br />
<div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;">The combination of LBBB morphology and inferior/right axis deviation is consistent with Right Ventricular Outflow Tract Tachycardia (RVOT). This is a type of monomorphic VT originating from the <a href="http://www.vhlab.umn.edu/atlas/right-ventricle/rvot-right-ventricle-outflow-tract/index.shtml" target="_blank">right outflow tract or tricuspid annulus</a> it is commonly seen in structurally normal hearts and is usually haemodynamically well tolerated. </span><span style="font-family: Arial, Helvetica, sans-serif;">RVOT can be terminated with vagal maneuvers, adenosine and is also sensitive to verapamil, t</span>his patient reverted following vagal manoeuvres. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">RVOT can also be seen in arrhythmogenic right ventricular dysplasia (ARVD).</span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">There is a great and brief overview of idiopathic ventricular tachycardias from the E-Journal of the ESC Council for Cardiology Practice that I would recommend:</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;"><a href="http://www.escardio.org/Guidelines-&-Education/Journals-and-publications/ESC-journals-family/E-journal-of-Cardiology-Practice/Volume-8/How-to-recognise-and-manage-idiopathic-ventricular-tachycardia#.VSEMw_mUd8E" target="_blank">Diez DP, Brugada J. How to recognise and manage idiopathic ventricular tachycardia.E-Journal of the ESC Council for Cardiology Practice. March 2010.</a></span></li>
</ul>
<span style="font-family: Arial, Helvetica, sans-serif;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><strong>References / Further Reading</strong></span><br /><br /><span style="font-family: "arial" , "helvetica" , sans-serif;">Life in the Fast Lane</span></span></span><br />
<ul><a href="https://litfl.com/right-ventricular-outflow-tract-rvot-tachycardia/" target="_blank"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
</span></a>
<li><span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://litfl.com/right-ventricular-outflow-tract-rvot-tachycardia/" target="_blank">Right Ventricular Outflow Tract Tachycardia </a></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial";"><span style="font-family: Arial, Helvetica, sans-serif;">Textbook</span></span></span><br />
<ul><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
</span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;">Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.</span></span></li>
</ul>
</div>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com0tag:blogger.com,1999:blog-1199060416202745408.post-10433099371587576252019-01-18T08:30:00.000+08:002019-01-18T08:30:11.356+08:00ECG of the Week - 21st January 2019<span style="font-family: Arial, Helvetica, sans-serif;">The following ECG is from a 34 year old female who presented with palpitations and dysponea.</span><br />
<br />
<a name='more'></a><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyjMnemOAtn9Dmtup9e7V9axoEKi7DmOlAMUKQvBclM-0Ld_250EVX5Lr04_Vc5FQ94X6ibzZrVgNIX1sE1YIhGYQEQdRJcPIvT6V084WUCI8sBGc-I4Wdt_hyphenhyphenJgZhJ2fkizHmiebw6TOX/s1600/ECG472.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" data-original-height="788" data-original-width="1600" height="196" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyjMnemOAtn9Dmtup9e7V9axoEKi7DmOlAMUKQvBclM-0Ld_250EVX5Lr04_Vc5FQ94X6ibzZrVgNIX1sE1YIhGYQEQdRJcPIvT6V084WUCI8sBGc-I4Wdt_hyphenhyphenJgZhJ2fkizHmiebw6TOX/s400/ECG472.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Click to enlarge</span></td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Things to think about</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What are they key ECG abnormalities ?</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">How would you treat this patient ?</span></li>
</ul>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com0tag:blogger.com,1999:blog-1199060416202745408.post-15830258525275462302019-01-16T13:30:00.000+08:002019-01-16T13:30:09.725+08:00ECG of the Week - 14th January 2019 - Interpretation<span style="font-family: "arial" , "helvetica" , sans-serif;">The following ECG is from a 45 yr old male who presented complaining of weakness and lethargy.</span><br />
<a name='more'></a><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjlEUM1aA2nCk4PIyYTdbNziRZwC4nXeylFWh-AHz66WIsYH7U_4rPTwwGiRDI0UOgxPmTjkJNw5APu2HbZa8KusryPBToEHnFffqj2yspN0ql4Hwxq81eg2zURgFqqP_6MZtPEjSJUG-9U/s1600/ECG471.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><img border="0" data-original-height="778" data-original-width="1600" height="193" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjlEUM1aA2nCk4PIyYTdbNziRZwC4nXeylFWh-AHz66WIsYH7U_4rPTwwGiRDI0UOgxPmTjkJNw5APu2HbZa8KusryPBToEHnFffqj2yspN0ql4Hwxq81eg2zURgFqqP_6MZtPEjSJUG-9U/s400/ECG471.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Click to enlarge</span></td></tr>
</tbody></table>
<br />
<ul>
</ul>
<div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;">Rate:</span></span><br />
<ul><span style="font-family: arial, helvetica, sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
</span>
<li><span style="font-family: arial, helvetica, sans-serif;">48 bpm</span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Rhythm:</span></span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Regular</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Sinus bradycardia</span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Axis:</span></span><br />
<ul><span style="font-family: arial, helvetica, sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
</span>
<li><span style="font-family: arial, helvetica, sans-serif;">Normal</span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Intervals:</span></span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">PR - Normal <span style="font-size: xx-small;">(~200ms)</span></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">QRS - Prolonged <span style="font-size: xx-small;">(120ms)</span></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">QT - 620ms</span></span></li>
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Apparent due to T-U fusion</span></span></li>
</ul>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;">Additional:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">ST Depression leads I, II, aVF, V2-6</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">'Down-up' T wave</span></li>
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Secondary to T-U fusion</span></li>
</ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Significant lead artifact in all precordial leads</span></li>
</ul>
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Interpretation:</span></span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">ECG features consistent with hypokalaemia</span></li>
</ul>
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>What happened ?</b></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">The patient had a K of 1.4 mmol/L !! They were admitted to critical care for monitoring during replacement.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Hypokalemia ECG's on the Web</b></span><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><br />
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">ECG of the Week - We've had some examples of hypokalemia previous check them out <a href="http://jhcedecg.blogspot.com.au/2013/03/ecg-of-week-11th-march-2013_13.html" target="_blank">here </a>& <a href="http://jhcedecg.blogspot.com.au/2012/12/ecg-of-week-24th-december-2012_26.html" target="_blank">here</a>.</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Dr Smith's ECG Blog - multiple great examples of hypokalaemic ECGs <a href="http://hqmeded-ecg.blogspot.com.au/search/label/hypokalemia" target="_blank">here</a>.</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Dr Ken Grauer's ECG Interpretation - A great walk through of ECG changes in hypokalaemia <a href="http://ecg-interpretation.blogspot.com.au/2011/08/ecg-interpretation-review-27-st-t-wave.html" target="_blank">here</a>.</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Amal Mattu's ECG Video - ECG findings in severe hypokalaemia <a href="http://ekgumem.tumblr.com/post/23481576099/ecg-findings-of-severe-hypokalemia-episode" target="_blank">here</a>.</span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<strong style="font-family: arial, helvetica, sans-serif;">References / Further Reading</strong><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /><span style="font-family: "arial" , "helvetica" , sans-serif;">Life in the Fast Lane</span></span><br />
<ul><a href="https://litfl.com/hypokalaemia-ecg-library/" target="_blank"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
</a>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><a href="https://litfl.com/hypokalaemia-ecg-library/" target="_blank">Hypokalaemia</a></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial";"><span style="font-family: "arial" , "helvetica" , sans-serif;">Textbook</span></span></span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">C<span style="font-family: "arial" , "helvetica" , sans-serif;">han TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.</span></span></span></li>
</ul>
</div>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com0tag:blogger.com,1999:blog-1199060416202745408.post-6270840749114393712019-01-11T08:30:00.000+08:002019-01-11T08:30:10.261+08:00ECG of the Week - 14th January 2019<span style="font-family: Arial, Helvetica, sans-serif;">The following ECG is from a 45 yr old male who presented complaining of weakness and lethargy.</span><br />
<br />
<a name='more'></a><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjlEUM1aA2nCk4PIyYTdbNziRZwC4nXeylFWh-AHz66WIsYH7U_4rPTwwGiRDI0UOgxPmTjkJNw5APu2HbZa8KusryPBToEHnFffqj2yspN0ql4Hwxq81eg2zURgFqqP_6MZtPEjSJUG-9U/s1600/ECG471.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" data-original-height="778" data-original-width="1600" height="193" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjlEUM1aA2nCk4PIyYTdbNziRZwC4nXeylFWh-AHz66WIsYH7U_4rPTwwGiRDI0UOgxPmTjkJNw5APu2HbZa8KusryPBToEHnFffqj2yspN0ql4Hwxq81eg2zURgFqqP_6MZtPEjSJUG-9U/s400/ECG471.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Click to enlarge</span></td></tr>
</tbody></table>
<b><span style="font-family: Arial, Helvetica, sans-serif;">Things to think about</span></b><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What are the key ECG abnormalities ?</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What are the potential causes for these features ?</span></li>
</ul>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com0tag:blogger.com,1999:blog-1199060416202745408.post-44770288257058543382019-01-09T13:30:00.000+08:002019-01-12T12:28:38.761+08:00ECG of the Week - 7th January 2019 - Interpretation<span style="font-family: "arial" , "helvetica" , sans-serif;">The following ECG is from a 25 yr old female who presented complaining of palpitations for the last hour.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<br />
<a name='more'></a><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
</span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWIoE4aZ4RkfVmyqFNfECSLrYX85Zk6PeRiMYkrYQ1jZ0WF8QFhc5RqzPK43ygPeDupsZs8qqbtxzu0fOe6dhHn9c42xirOPbIIGCFQ9dRA_ROP_c5aSvYNQtpkFcxyJgYuCpH64lcPbbP/s1600/ECG470.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" data-original-height="784" data-original-width="1600" height="195" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWIoE4aZ4RkfVmyqFNfECSLrYX85Zk6PeRiMYkrYQ1jZ0WF8QFhc5RqzPK43ygPeDupsZs8qqbtxzu0fOe6dhHn9c42xirOPbIIGCFQ9dRA_ROP_c5aSvYNQtpkFcxyJgYuCpH64lcPbbP/s400/ECG470.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Click to enlarge</span></td></tr>
</tbody></table>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;">Rate:</span><br />
<div>
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
</span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">205 bpm</span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Rhythm:</span></span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
</span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Regular</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Nil P waves visible</span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Axis:</span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
</span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Normal</span></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Intervals:</span></span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
</span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">QRS - Normal <span style="font-size: xx-small;">(80ms)</span></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Additional:</span><br />
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Diffuse ST depression leads I, II, III, aVF, V2-6</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">ST Elevation leads aVR, V1 & aVL</span></li>
</ul>
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Interpretation:</b></span></span><br />
<br />
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Regular narrow complex tachycardia</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">ST segment changes likely secondary to high ventricular rate</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">DDx:</span></li>
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">AVNRT</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">AVRT (orthodromic)</span></li>
</ul>
</ul>
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Management</b> </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Management of SVT is dependent on haemodynamic stability, likely underlying cause, facilities / resources available and patient's wishes.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">It usually follows a step-wise approach, assuming no compromise:</span><br />
<br />
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Vagal maneouvers</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Adenosine</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Other drug options</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">DC Cardioversion</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Simultaneous seek and treat cause - usually absent in most AVNRT</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Ablation therapy - elective rather than emergent</span></li>
</ul>
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><strong>References / Further Reading</strong></span><br /><br /><span style="font-family: "arial" , "helvetica" , sans-serif;">Life in the Fast Lane</span></span><br />
<ul><a href="https://litfl.com/supraventricular-tachycardia-svt-ecg-library/" target="_blank"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
</span></a>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><a href="https://litfl.com/supraventricular-tachycardia-svt-ecg-library/" target="_blank">SVT</a></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial";"><span style="font-family: "arial" , "helvetica" , sans-serif;">Textbook</span></span></span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
</span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.</span></span></li>
</ul>
</div>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com0tag:blogger.com,1999:blog-1199060416202745408.post-60686545502377021612019-01-04T08:30:00.000+08:002019-01-12T12:29:06.476+08:00ECG of the Week - 7th January 2019<span style="font-family: "arial" , "helvetica" , sans-serif;">The following ECG is from a 25 yr old female who presented complaining of palpitations for the last hour.</span><br />
<br />
<a name='more'></a><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_UWgjHXVJ0XG9SaV-jj4t1YBUgAnB9h4emQs4V6cJ8G4rvaGglcjmGYXHvlv6r_8j5dLh2w6eR45e5EwULukOej5TRFJ-lhjAUaM3wM9ysOKADI_Hc-rnKP126Tozgysmtw7mPuJtxQQH/s1600/ECG470.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="784" data-original-width="1600" height="195" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_UWgjHXVJ0XG9SaV-jj4t1YBUgAnB9h4emQs4V6cJ8G4rvaGglcjmGYXHvlv6r_8j5dLh2w6eR45e5EwULukOej5TRFJ-lhjAUaM3wM9ysOKADI_Hc-rnKP126Tozgysmtw7mPuJtxQQH/s400/ECG470.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Click to enlarge</span></td></tr>
</tbody></table>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Things to think about</b></span><br />
<br />
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">What are the key ECG features ?</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">How would you manage this patient ?</span></li>
</ul>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com0tag:blogger.com,1999:blog-1199060416202745408.post-5766893482349481142019-01-02T13:30:00.000+08:002019-01-02T13:30:12.165+08:00ECG of the Week - 31st December 2018 - Interpretation<span style="font-family: Arial, Helvetica, sans-serif;">The following ECG is from a 34 yr old female who presented following thyroid surgery complaining of cramping.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;"></span><br /></span>
<a name='more'></a><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj12WNA07KypHah-rQlpz5XIQlVqb9eIsplLizfd-KBxAQQItOt4w5jjJPYNyhlhBR3ZybEtwWJXnERr0TCMWKS8Imba9nqmDM4FinT9ES6ekB37a74OI072OlI_bE7uqljOxIHSNGLRMu0/s1600/ECG469.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" data-original-height="773" data-original-width="1600" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj12WNA07KypHah-rQlpz5XIQlVqb9eIsplLizfd-KBxAQQItOt4w5jjJPYNyhlhBR3ZybEtwWJXnERr0TCMWKS8Imba9nqmDM4FinT9ES6ekB37a74OI072OlI_bE7uqljOxIHSNGLRMu0/s400/ECG469.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Click to enlarge</span></td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif;">Rate:</span><br />
<div>
<ul><span style="font-family: Arial, Helvetica, sans-serif;"></span>
<li><span style="font-family: Arial, Helvetica, sans-serif;">60 bpm<span style="font-family: "arial" , "helvetica" , sans-serif;"></span></span></li>
</ul>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Rhythm:</span></span><br />
<ul><span style="font-family: Arial, Helvetica, sans-serif;"></span>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Regular</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Sinus rhythm</span></li>
</ul>
<span style="font-family: Arial, Helvetica, sans-serif;">Axis:</span><br />
<ul><span style="font-family: Arial, Helvetica, sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;">Normal</span></span></li>
</ul>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Intervals:</span></span><br />
<ul><span style="font-family: Arial, Helvetica, sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;">PR - Prolonged <span style="font-size: xx-small;">(~220ms)</span></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;">QRS - Prolonged <span style="font-size: xx-small;">(110ms)</span></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;">QT - 480ms</span></span></li>
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;">Note prolonged ST segment with relatively normal size T wave</span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;">Absence of U waves</span></span></li>
</ul>
</ul>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;">Additional:</span></span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Late R wave transition</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Broad P wave in lead II</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">ST depression and biphasic (down-up) T wave in leads V4-6</span></li>
</ul>
<br />
<b><span style="font-family: Arial, Helvetica, sans-serif;">What happened ?</span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">The patient had a corrected calcium of 1.99 (normal 2.2-2.55 mmol/L) and mild hyperkalaemia and hypermagnesaemia.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Classical ECG features of h</span>ypocalcaemia are ST segment prolongation resulting in QTc prolongation; there are also reports of T wave flattening and inversion associated with hypocalcaemia, and even ST elevation likely secondary to coronary vasospasm.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">The PR prolongation and QRS widening are likely due to the other electrolyte abnormalities, the lateral T inversion may also be due to electrolyte abnormality but serial ECG's, comparison with old ECG's and a focused history exploring potential for other causes (ischaemia, cardiomyopathy, drugs) would be useful to exclude more sinister causes.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>Complications of thyroid surgery</b></span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Haematoma / Haemorrhage - Can result in airway compression</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Recurrent laryngeal nerve injury</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Hypocalcaemia secondary iatrogenic hypoparathyroidism</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Infection - superficial / deep</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Seroma</span></li>
</ul>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><strong>References / Further Reading</strong></span><br /><br /><span style="font-family: "arial" , "helvetica" , sans-serif;">Life in the Fast Lane</span></span><br />
<ul><a href="https://litfl.com/hypocalcaemia-ecg-library/" target="_blank"><span style="font-family: Arial, Helvetica, sans-serif;"></span></a>
<li><span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://litfl.com/hypocalcaemia-ecg-library/" target="_blank">Hypocalcaemia</a></span></li>
</ul>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: "arial";"><span style="font-family: "arial" , "helvetica" , sans-serif;">Textbook</span></span></span><br />
<ul><span style="font-family: Arial, Helvetica, sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;">Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.</span></span></li>
</ul>
</div>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com0tag:blogger.com,1999:blog-1199060416202745408.post-19915562794410861682018-12-28T08:30:00.000+08:002018-12-28T08:31:56.043+08:00ECG of the Week - 31st December 2018<span style="font-family: Arial, Helvetica, sans-serif;">The following ECG is from a 34 yr old female who presented following thyroid surgery complaining of cramping.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<a name='more'></a><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj12WNA07KypHah-rQlpz5XIQlVqb9eIsplLizfd-KBxAQQItOt4w5jjJPYNyhlhBR3ZybEtwWJXnERr0TCMWKS8Imba9nqmDM4FinT9ES6ekB37a74OI072OlI_bE7uqljOxIHSNGLRMu0/s1600/ECG469.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" data-original-height="773" data-original-width="1600" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj12WNA07KypHah-rQlpz5XIQlVqb9eIsplLizfd-KBxAQQItOt4w5jjJPYNyhlhBR3ZybEtwWJXnERr0TCMWKS8Imba9nqmDM4FinT9ES6ekB37a74OI072OlI_bE7uqljOxIHSNGLRMu0/s400/ECG469.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Click to enlarge</span></td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>Things to think about</b></span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What are the key ECG abnormalities ?</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What complications are associated with thyroid surgery ?</span></li>
</ul>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com0tag:blogger.com,1999:blog-1199060416202745408.post-11445579860206444612018-12-26T13:30:00.000+08:002018-12-26T13:30:02.825+08:00ECG of the Week - 24th December 2018 - Interpretation<span style="font-family: "arial" , "helvetica" , sans-serif;">The following ECG is from a 30 yr old male who presented with a 48 hour history of positional left sided chest pain. He is normally fit and well.</span><br />
<br />
<a name='more'></a><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgH8D_OnMUVofviCaBXW2lTT6RDxppmYJiMzNaEDY_sCB7RkXL8odi_6U_x-gAMHofqi_HSUVacNK_vy20Ppe66gnpCTuyvTu2iLAbZZsznLu7JpQDiJj8AdYGOATBZuYZDW8qHA48tdCMP/s1600/ECG468.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><img border="0" data-original-height="771" data-original-width="1600" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgH8D_OnMUVofviCaBXW2lTT6RDxppmYJiMzNaEDY_sCB7RkXL8odi_6U_x-gAMHofqi_HSUVacNK_vy20Ppe66gnpCTuyvTu2iLAbZZsznLu7JpQDiJj8AdYGOATBZuYZDW8qHA48tdCMP/s400/ECG468.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: small;">Click to enlarge</span></td></tr>
</tbody></table>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;">Rate:</span></span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: arial, helvetica, sans-serif;">84 bpm</span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Rhythm:</span></span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Regular</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Sinus rhythm</span></li>
</ul>
<span style="font-family: arial, helvetica, sans-serif;">Axis:</span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Normal</span></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Intervals:</span></span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">PR - Normal <span style="font-size: xx-small;">(~200ms)</span></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">QRS - Normal <span style="font-size: xx-small;">(100ms)</span></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">QT - 340ms <span style="font-size: xx-small;">(QTc Bazette 400 ms)</span></span></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;">Additional:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">ST Elevation leads I, II, III, aVF, V1-6</span></li>
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Concave morphology</span></li>
</ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">ST Depression lead aVR</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">PR depression globally (expect aVL & aVR)</span></li>
</ul>
<br />
<span style="font-family: arial, helvetica, sans-serif;">Interpretation:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Clinical history and ECG features consistent with pericarditis</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Potential element of underlying BERP - no old ECG's to compare</span></li>
</ul>
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">What happened ?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">The patient had negative serial troponins and an echo which did not show a pericardial effusion. A diagnosis of uncomplicated pericarditis was made and he was discharged with NSAIDs.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Pericarditis has multiple causes including:</span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Infective - viral, bacterial, fungal, TB</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Auto-immune - SLE</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Malignant</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Uraemic</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Traumatic</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Post myocardial infarction</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Post surgical</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Post radiotherapy</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Drug induced</span></li>
</ul>
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><strong>References / Further Reading</strong></span><br /><br /><span style="font-family: "arial" , "helvetica" , sans-serif;">Life in the Fast Lane</span></span><br />
<ul><a href="https://litfl.com/pericarditis-ecg-library/" target="_blank"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span></a>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><a href="https://litfl.com/pericarditis-ecg-library/" target="_blank">Pericarditis</a></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial";"><span style="font-family: "arial" , "helvetica" , sans-serif;">Textbook</span></span></span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">C<span style="font-family: "arial" , "helvetica" , sans-serif;">han TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.</span></span></span></li>
</ul>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com0tag:blogger.com,1999:blog-1199060416202745408.post-41068185158687514582018-12-21T07:52:00.000+08:002018-12-21T07:52:55.892+08:00ECG of the Week - 24th December 2018<span style="font-family: Arial, Helvetica, sans-serif;">The following ECG is from a 30 yr old male who presented with a 48 hour history of positional left sided chest pain. He is normally fit and well.</span><br />
<br />
<a name='more'></a><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgH8D_OnMUVofviCaBXW2lTT6RDxppmYJiMzNaEDY_sCB7RkXL8odi_6U_x-gAMHofqi_HSUVacNK_vy20Ppe66gnpCTuyvTu2iLAbZZsznLu7JpQDiJj8AdYGOATBZuYZDW8qHA48tdCMP/s1600/ECG468.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" data-original-height="771" data-original-width="1600" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgH8D_OnMUVofviCaBXW2lTT6RDxppmYJiMzNaEDY_sCB7RkXL8odi_6U_x-gAMHofqi_HSUVacNK_vy20Ppe66gnpCTuyvTu2iLAbZZsznLu7JpQDiJj8AdYGOATBZuYZDW8qHA48tdCMP/s400/ECG468.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Click to enlarge</span></td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<b><span style="font-family: Arial, Helvetica, sans-serif;">Things to think about</span></b><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What are the key ECG abnormalities ?</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What are the potential causes and complications ?</span></li>
</ul>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com0tag:blogger.com,1999:blog-1199060416202745408.post-8225369551873754612018-12-19T13:30:00.000+08:002018-12-19T13:30:11.673+08:00ECG of the Week - 17th December 2018 - Interpretation<span style="font-family: "arial" , "helvetica" , sans-serif;">The following ECG is from a 55 yr old female who presented complaining of chest pain and dysponea.</span><br />
<br />
<a name='more'></a><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9BS0XcUPOt-uDN3GnKQl_mJWa2Ncr7n7tI9Mldxe96iE7PzvCJ3XupcMknEr9VMYHYuEZOPDpfPprRTdAWh4HMuWtyinNouuzrNAA1-lZxXS2aQNvMNtWIeMptQwqqayO_tCUmASZCXvm/s1600/ECG467.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><img border="0" data-original-height="781" data-original-width="1600" height="195" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9BS0XcUPOt-uDN3GnKQl_mJWa2Ncr7n7tI9Mldxe96iE7PzvCJ3XupcMknEr9VMYHYuEZOPDpfPprRTdAWh4HMuWtyinNouuzrNAA1-lZxXS2aQNvMNtWIeMptQwqqayO_tCUmASZCXvm/s400/ECG467.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: small;">Click to enlarge</span></td></tr>
</tbody></table>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;">Rate:</span></span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">72 bpm</span></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Rhythm: </span></span><ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Regular </span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Sinus Rhythm </span></li>
</ul>
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Axis:</span></span><ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">RAD</span></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Intervals:</span></span><ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">PR - Normal <span style="font-size: xx-small;">(~160ms)</span></span> </span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">QRS - Normal <span style="font-size: xx-small;">(60ms)</span></span> </span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Additional:</span></span></div>
</span><ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>Complete lead inversion leads I & aVL</span></span></span></span></li>
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">P / QRS / T inversion</span></span></span></li>
</ul>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span></span></span><div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Interpretation:</span></span></span></span></div>
<ul>
<li>Lead reversal LA / RA</li>
<ul>
<li>Results in:</li>
<ul>
<li>Inversion of lead I</li>
<li>Switch of aVR & aVL</li>
<li>Switch of II & III</li>
</ul>
</ul>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><strong>References / Further Reading</strong></span></span><div>
</div>
<div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Life in the Fast Lane</span></span></div>
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><a href="https://litfl.com/ecg-limb-lead-reversal-ecg-library/" target="_blank">Lead reversal</a></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial";"><span style="font-family: "arial" , "helvetica" , sans-serif;">Textbook</span></span></span><div>
</div>
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">C<span style="font-family: "arial" , "helvetica" , sans-serif;">han TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.</span><span style="font-family: "times new roman";"> </span></span></span></li>
</ul>
<br />Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com0tag:blogger.com,1999:blog-1199060416202745408.post-72542372487295744342018-12-14T08:30:00.000+08:002018-12-14T08:30:09.380+08:00ECG of the Week - 17th December 2018<span style="font-family: Arial, Helvetica, sans-serif;">The following ECG is from a 55 yr old female who presented complaining of chest pain and dysponea.</span><br />
<br />
<a name='more'></a><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9BS0XcUPOt-uDN3GnKQl_mJWa2Ncr7n7tI9Mldxe96iE7PzvCJ3XupcMknEr9VMYHYuEZOPDpfPprRTdAWh4HMuWtyinNouuzrNAA1-lZxXS2aQNvMNtWIeMptQwqqayO_tCUmASZCXvm/s1600/ECG467.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" data-original-height="781" data-original-width="1600" height="195" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9BS0XcUPOt-uDN3GnKQl_mJWa2Ncr7n7tI9Mldxe96iE7PzvCJ3XupcMknEr9VMYHYuEZOPDpfPprRTdAWh4HMuWtyinNouuzrNAA1-lZxXS2aQNvMNtWIeMptQwqqayO_tCUmASZCXvm/s400/ECG467.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Click to enlarge</span></td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<b><span style="font-family: Arial, Helvetica, sans-serif;">Things to think about</span></b><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What are the key ECG features ?</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">How would you manage this scenario ?</span></li>
</ul>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com0tag:blogger.com,1999:blog-1199060416202745408.post-91677396857806779482018-12-12T13:30:00.000+08:002018-12-12T13:30:05.422+08:00ECG of the Week - 10th December 2018 - Interpretation<span style="font-family: "arial" , "helvetica" , sans-serif;">The following ECG is from an 80 yr old male who presented with chest pain.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><div>
</div>
<a name='more'></a><span style="font-family: "arial" , "helvetica" , sans-serif;"></span><div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span> </div>
<div>
</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhd7HixNQxJazubtFRe60w730A9DxiqjvwaMUSMhqpi0QF2PAdS0wiOkIXGSmkwFzyvErCm6yUuB8Aw2CYRBa41Ipbw1Gdj8_Z-_WdP-wGPggag8hU78nuW60Uj76R3adu1ZwIc0ja3nu6D/s1600/ECG466.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><img border="0" data-original-height="777" data-original-width="1600" height="193" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhd7HixNQxJazubtFRe60w730A9DxiqjvwaMUSMhqpi0QF2PAdS0wiOkIXGSmkwFzyvErCm6yUuB8Aw2CYRBa41Ipbw1Gdj8_Z-_WdP-wGPggag8hU78nuW60Uj76R3adu1ZwIc0ja3nu6D/s400/ECG466.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: small;">Click to enlarge</span></td></tr>
</tbody></table>
<span style="font-family: "arial" , "helvetica" , sans-serif;"></span><div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;">Rate:</span></span></div>
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">84 bpm<span style="font-family: "arial" , "helvetica" , sans-serif;"></span></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Rhythm:</span></span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Regular</span></li>
<li><span style="font-family: Arial;">Sinus rhythm - P waves best seen in leads V2-3</span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Axis:</span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Normal</span></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Intervals:</span></span><br />
<ul><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">QRS - Normal</span></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span><span style="font-family: "arial" , "helvetica" , sans-serif;">Additional:</span></span><br />
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>Significant baseline artefact</span></span></span></li>
<li><span style="font-family: Arial;">ST elevation leads V1-3</span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span></span></span><div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Interpretation:</span></span></span></span></div>
<ul>
<li><span style="font-family: Arial;">Baseline artefact</span></li>
<li><span style="font-family: Arial;">Secondary to pre-existing Parkinson's disease</span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b></b></span><div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="background-color: white;"><b>Troubleshooting </b></span><b>artefact</b></span></div>
<div>
<div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"> <span style="background-color: white;">There are multiple factors that can generate artifact during the ECG recording / printing process including:</span><div style="background-color: white;">
</div>
</span></div>
<ul style="background-color: white; line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;"><span style="font-family: "arial" , "helvetica" , sans-serif;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Patient factors</li>
<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Implanted devices</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">PPM - Pacing Spikes</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">Nerve stimulators</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">Movement disorders e.g. Parkinson's, essential tremor</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">Rigors</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">Muscle tremor / activity can be related to pain, hypothermia etc.</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">CPR</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">Habitus - very thin or obese patients, paediatric patients</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">Poor pad contact due to hair</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">Poor pad contact due to moisture - sweating, immersion etc.</li>
</ul>
<li style="margin: 0px 0px 0.25em; padding: 0px;">Lead factors</li>
<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Poor pad contact</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">Pad misplacement</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">Damaged lead or lead connection</li>
</ul>
<li style="margin: 0px 0px 0.25em; padding: 0px;">ECG Machine Factors</li>
<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Inappropriate settings of gain or filtering modes</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">Electrical artifact from power supply</li>
</ul>
<li style="margin: 0px 0px 0.25em; padding: 0px;">Printing factors</li>
<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Low ink</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">Print head tracking</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">Paper alignment</li>
</ul>
<li style="margin: 0px 0px 0.25em; padding: 0px;">External factors</li>
<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Interference from surrounding electronic devices. Relatively rare using newer ECG machines and environmental interference is usually compounded by incorrect machine filter settings.</li>
</ul>
</span></ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;">
<div style="background-color: white;">
An awareness of these factors and a systemic approach to addressing each point in the recording process, from patient to printer, is important in addressing recording problems such as artifact and lead mal-positioning.<br />
<div>
</div>
</div>
<div style="background-color: white;">
<br /></div>
<div style="background-color: white;">
<div style="font-family: "Times New Roman";">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><strong>References / Further Reading</strong></span></span></div>
<br />
<div style="font-family: "Times New Roman";">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial";"><span style="font-family: "arial" , "helvetica" , sans-serif;">Textbook</span></span></span></div>
<ul style="font-family: "Times New Roman";"><span style="font-family: "arial" , "helvetica" , sans-serif;"></span>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;">C<span style="font-family: "arial" , "helvetica" , sans-serif;">han TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.</span></span></span></li>
</ul>
</div>
</span><br /></div>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com0tag:blogger.com,1999:blog-1199060416202745408.post-54865415806476194452018-12-07T08:30:00.000+08:002018-12-07T08:30:02.207+08:00ECG of the Week - 10th December 2018<span style="font-family: Arial, Helvetica, sans-serif;">The following ECG is from an 80 yr old male who presented with chest pain.</span><br />
<br />
<a name='more'></a><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhd7HixNQxJazubtFRe60w730A9DxiqjvwaMUSMhqpi0QF2PAdS0wiOkIXGSmkwFzyvErCm6yUuB8Aw2CYRBa41Ipbw1Gdj8_Z-_WdP-wGPggag8hU78nuW60Uj76R3adu1ZwIc0ja3nu6D/s1600/ECG466.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" data-original-height="777" data-original-width="1600" height="193" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhd7HixNQxJazubtFRe60w730A9DxiqjvwaMUSMhqpi0QF2PAdS0wiOkIXGSmkwFzyvErCm6yUuB8Aw2CYRBa41Ipbw1Gdj8_Z-_WdP-wGPggag8hU78nuW60Uj76R3adu1ZwIc0ja3nu6D/s400/ECG466.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Click to enlarge</span></td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><b>Things to think about</b></span><br />
<br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What are the key ECG features ?</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">What are your differentials for these features ?</span></li>
</ul>
Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.com0