Heart pearls! » ECG http://www.heartpearls.com For all cardiology enthusiasts! Bonjour! Click on the title above to go to site index so that you can browse the articles! Sun, 18 Jul 2010 07:59:48 +0000 http://wordpress.org/?v=2.8.4 en hourly 1 ECG image – 009 http://www.heartpearls.com/2009/08/ecg-image-009.html http://www.heartpearls.com/2009/08/ecg-image-009.html#comments Mon, 17 Aug 2009 11:05:29 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/?p=628 adenosine unmasking atrial tachycardia

adenosine unmasking atrial tachycardia

Click on image for a larger view.

Atrial tachycardia unmasked by adenosine.

ECG contributed by Dr Anoop C Parameshwaran MD MPH.

]]> http://www.heartpearls.com/2009/08/ecg-image-009.html/feed 1 ECG image -007 http://www.heartpearls.com/2009/07/ecg-007.html http://www.heartpearls.com/2009/07/ecg-007.html#comments Mon, 27 Jul 2009 16:26:54 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/?p=521 Click on image to enlarge.

acute pericarditis ecg image

Diagnosis- acute pericarditis

Pointers-

1. Diffuse concave up ST segment elevation.

2. T waves are concordant with ST segment.

3. ST segment depression in aVR and v1.

4. PR segment depression.

5. Absence of reciprocal ST segment depression.

Comments are welcome!

Further reading on the web- http://www.aafp.org/afp/980215ap/marinell.html

]]> http://www.heartpearls.com/2009/07/ecg-007.html/feed 0 ECG image -006 http://www.heartpearls.com/2009/07/ecg-006.html http://www.heartpearls.com/2009/07/ecg-006.html#comments Mon, 27 Jul 2009 14:57:38 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/?p=516 Click on image to enlarge.

ARVC ARVD epsilon ecg

Diagnosis- Arrhythmogenic RV dysplasia

Pointers-

1. Epsilon wave

2. T inversion in v 1 to v3

3. Positive QRS in v1 (the classical RBBB pattern is not present in this ECG)

Comments are welcome.

]]> http://www.heartpearls.com/2009/07/ecg-006.html/feed 0 ECG image -005 http://www.heartpearls.com/2009/07/ecg-005.html http://www.heartpearls.com/2009/07/ecg-005.html#comments Mon, 27 Jul 2009 14:38:53 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/?p=511 Click on image to enlarge

WPW preexcitation accessory pathway left lateral ecg

Diagnosis- pre-excitation with left lateral accessory pathway.

Pointers-

1. Short PR interval and delta wave – pre-excitation.

2. Positive delta in v1- left sided pathway.

3. Positive delta in avF- left lateral pathway.

Comments are welcome!

]]> http://www.heartpearls.com/2009/07/ecg-005.html/feed 0 ECG image -004 http://www.heartpearls.com/2009/07/ecg-004.html http://www.heartpearls.com/2009/07/ecg-004.html#comments Mon, 27 Jul 2009 11:20:53 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/?p=501 Click on image to enlarge.

right ventricular outflow tract ventricular tachycardia ecg image

Diagnosis- RVOT ventricular tachycardia (RVOT – Right ventricular outflow tract)

Pointers-

1. The first two beats are wide complex. Then sinus rhythm is seen. Wide complex tachycardia recurs after 5 sinus beats. The last beat is a sinus beat.

2. P waves dissociated from the QRS can be seen in the bottom rhythm strip (lead II) in the second group of wide complex beats- so the tachycardia is VT.

3. LBBB pattern + inferior axis. This is the characteristic pattern in RVOT VT. Inferior axis is inferred from the first two wide complex beats seen in leads I, II and III.

Comments are welcome!

]]> http://www.heartpearls.com/2009/07/ecg-004.html/feed 0 ECG image -003 http://www.heartpearls.com/2009/07/ecg-003.html http://www.heartpearls.com/2009/07/ecg-003.html#comments Mon, 27 Jul 2009 11:03:04 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/?p=496 Belhassen VT with capture beat

Belhassen ventricular tachycardia ecg image

Diagnosis- Belhassen’s tachycardia (posterior fascicular ventricular tachycardia)

Pointers-

1. QRS is wide, but not very wide, the width being 120 msec. This makes it difficult to differentiate whether this is VT or SVT.

2. Capture beat indicating that it is VT, not SVT.

3. RBBB + left axis deviation, the characteristic pattern in Belhassen’s tachycardia.

Comments are welcome!

]]> http://www.heartpearls.com/2009/07/ecg-003.html/feed 1 ECG-002 http://www.heartpearls.com/2009/07/ecg-002.html http://www.heartpearls.com/2009/07/ecg-002.html#comments Mon, 27 Jul 2009 10:19:24 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/?p=491 Click on image to enlarge.

arm lead reversal ecg image

Diagnosis- Arm lead reversal.

Pointers-

1. Precordial leads are normal.

2. In limb leads, QRS axis is 150 degrees and P axis is 120 degrees.

Comments are welcome!

]]> http://www.heartpearls.com/2009/07/ecg-002.html/feed 0 When do you suspect left main coronary artery disease from the ECG? http://www.heartpearls.com/2009/06/when-do-you-suspect-left-main-coronary-artery-disease-from-the-ecg.html http://www.heartpearls.com/2009/06/when-do-you-suspect-left-main-coronary-artery-disease-from-the-ecg.html#comments Wed, 03 Jun 2009 01:53:26 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/?p=202 Left main coronary artery disease is suspected from the ECG when we see-

1. ST elevation in aVR.

2. ST depression in leads I and II and in leads v4 to v6.

3. Sum of ST changes is 18 mm or more.

]]> http://www.heartpearls.com/2009/06/when-do-you-suspect-left-main-coronary-artery-disease-from-the-ecg.html/feed 1 ECG- Supraventricular tachycardia with aberrancy- features to distinguish from ventricular tachycardia http://www.heartpearls.com/2009/06/what-are-the-main-features-of-supraventricular-tachycardia-with-aberrancy-that-helps-to-distinguish-if-from-ventricular-tachycardia.html http://www.heartpearls.com/2009/06/what-are-the-main-features-of-supraventricular-tachycardia-with-aberrancy-that-helps-to-distinguish-if-from-ventricular-tachycardia.html#comments Tue, 02 Jun 2009 13:53:21 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/?p=197
  • RBBB pattern (rsR’ in v1 or qrS in v6).
  • Initial part of the complex is similar to a sinus rhythm complex.
  • Similar complexes seen earlier when patient was in sinus rhythm and then was clearly diagnosed as aberrant conduction.
  • Complex ending a short RR interval after a long RR interval (preceding long RR- short RR sequence; second in a row phenomenon; Ashman phenomenon).
  • The suspected complexes are all having preceding P waves.
  • RBBB and LBBB patterns seen- more likely to be alternating BBB due to varying aberrancy rather than ventricular tachycardias from both ventricles.
    • ]]>     http://www.heartpearls.com/2009/06/what-are-the-main-features-of-supraventricular-tachycardia-with-aberrancy-that-helps-to-distinguish-if-from-ventricular-tachycardia.html/feed 0     Can you rely on AV dissociation to differentiate ventricular tachycardia from supraventricular tachyarrhythmia with aberration? http://www.heartpearls.com/2009/06/can-you-rely-on-av-dissociation-to-differentiate-ventricular-tachycardia-from-supraventricular-tachyarrhythmia-with-aberration.html http://www.heartpearls.com/2009/06/can-you-rely-on-av-dissociation-to-differentiate-ventricular-tachycardia-from-supraventricular-tachyarrhythmia-with-aberration.html#comments Tue, 02 Jun 2009 13:35:31 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/?p=194 No, because-

    1. AV dissociation is not present in many VTs- due to retrograde conduction of ventricular tachycardia through the AV node to cause atrial activation.

    2. It may not be always possible to identify P waves on top of the VT. This is more common than appreciated.

    3. There may not be P waves- patient may be in atrial fibrillation along with VT!

    4. Sometimes junctional tachyarrhythmias may conduct down with aberrancy, but may not conduct up into the atria. So dissociated P waves will be present.

    ]]>     http://www.heartpearls.com/2009/06/can-you-rely-on-av-dissociation-to-differentiate-ventricular-tachycardia-from-supraventricular-tachyarrhythmia-with-aberration.html/feed 0