ECG Guru - Instructor Resources - PVCs https://www.ecgguru.com/ecg/pvcs en Sinus Rhythm With Ectopy https://www.ecgguru.com/ecg/sinus-rhythm-ectopy <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/sinus-rhythm-ectopy"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/MR%20Laddergram%20donated%20by%20Jason%20R.jpg" width="765" height="634" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal" align="left"><span style="font-size: 10pt; font-family: Verdana, sans-serif;">We originally published this ECG in 2012.&nbsp; It was generously donated to the ECG Guru website by our friend and ECG Guru Extraordinaire, Jason Roediger. &nbsp;We are re-publishing it today, as it is a great ECG for illustrating how helpful laddergrams can be for showing conduction in dysrhythmias.</span></p><p class="MsoNormal" align="left"><span style="font-size: 10pt; font-family: Verdana, sans-serif;">This ECG has something for everyone:&nbsp; The rhythm is sinus, and there is a non-conducted PAC (beat number 3) after the second beat.&nbsp; Just after the next P wave, there is a ventricular escape beat which prevents that P wave from making a QRS.&nbsp; The eighth beat is a PVC.&nbsp; The eleventh is a conducted PAC. &nbsp;You can use this ECG to illustrate for your students the concepts of "escape" beats, refractory periods, and premature beats.</span></p><p class="MsoNormal" align="left"><span style="font-size: 10pt; font-family: Verdana, sans-serif;">There are ST changes that suggest coronary artery disease: the ST segments are flat in&nbsp;shape with a tiny amount of elevation in V1 through V4.&nbsp; The axis is normal, at the border of normal and left axis. It is difficult to see, but there appears to be a tiny r wave in Lead III, so we cannot say for sure if there is or was a pathological Q wave in that lead.</span></p><p class="MsoNormal" align="left"><span style="font-size: 10pt; font-family: Verdana, sans-serif;">The P waves are wide and "double" in Lead II and biphasic in V1, suggesting LV failure or mitral valve disease.&nbsp; However, the criteria for LV hypertrophy are not met.</span></p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/100/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Sinus Rhythm With Ectopy 1/5</option><option value="40">Give Sinus Rhythm With Ectopy 2/5</option><option value="60">Give Sinus Rhythm With Ectopy 3/5</option><option value="80" selected="selected">Give Sinus Rhythm With Ectopy 4/5</option><option value="100">Give Sinus Rhythm With Ectopy 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.1</span></span> <span class="total-votes">(<span >14</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-H6BRkp3UZjcBUt1qJSjQVbTJlsbvbr2ZtNPjMKFkp3g" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/non-conducted-premature-atrial-contractions" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Non-conducted premature atrial contractions</a></div><div class="field-item odd"><a href="/ecg/pvcs" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">PVCs</a></div><div class="field-item even"><a href="/ecg/fusion-beats" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Fusion beats</a></div><div class="field-item odd"><a href="/ecg/ventricular-escape-beat" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ventricular escape beat</a></div><div class="field-item even"><a href="/ecg/laddergram" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Laddergram</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fsinus-rhythm-ectopy&amp;title=Sinus%20Rhythm%20With%20Ectopy"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Fri, 07 Aug 2015 02:56:29 +0000 Dawn 655 at https://www.ecgguru.com https://www.ecgguru.com/ecg/sinus-rhythm-ectopy#comments ECG BASICS: Sinus Rhythm With Ventricular Bigeminy https://www.ecgguru.com/ecg/ecg-basics-sinus-rhythm-ventricular-bigeminy <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/ecg-basics-sinus-rhythm-ventricular-bigeminy"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/102%20Ventricular%20Bigeminy.jpg" width="1800" height="298" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>Nice, clear example of ventricular bigeminy with an underlying sinus rhythm. &nbsp;We do not know from this strip if the sinus rhythm is a bradycardia at a rate of about 42 per minute, or if the underlying sinus rhythm is actually at a rate of 85 per minute, with every other sinus beat inhibited by the occurance of a PVC. &nbsp;In the first possibility, the ventricular beats would be considered "escape" beats, positively contributing to the patient's heart rate. &nbsp;In the second instance, the rather late-occurring PVCs would cause the heart to be refractory, preventing the sinus P wave from conducting it's impulse to the ventricles. &nbsp; Sometimes, we can see signs of the sinus P wave "hiding" in the PVC, but in this case, if P waves exist, they fall almost exactly in the middle of the ventricular beats' QRS complex, making them invisible. &nbsp;A good strategy would be to watch the strip continuously for some time, hoping to catch the conduction of two sinus beats in a row, solving the dilemma.</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/100/feed" method="post" id="fivestar-custom-widget--2" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--4" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give ECG BASICS: Sinus Rhythm With Ventricular Bigeminy 1/5</option><option value="40">Give ECG BASICS: Sinus Rhythm With Ventricular Bigeminy 2/5</option><option value="60">Give ECG BASICS: Sinus Rhythm With Ventricular Bigeminy 3/5</option><option value="80" selected="selected">Give ECG BASICS: Sinus Rhythm With Ventricular Bigeminy 4/5</option><option value="100">Give ECG BASICS: Sinus Rhythm With Ventricular Bigeminy 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.8</span></span> <span class="total-votes">(<span >6</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--2" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-oXMd_l-Efk-5QU-Cns7ZAffnSb5uH-B8_Qx81aMHD3E" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/ventricular-bigeminy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ventricular bigeminy</a></div><div class="field-item odd"><a href="/ecg/pvcs" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">PVCs</a></div><div class="field-item even"><a href="/ecg/ecg-basics" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ECG Basics</a></div><div class="field-item odd"><a href="/ecg/basic-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Basic ECG</a></div><div class="field-item even"><a href="/ecg/rhythm-strip" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Rhythm strip</a></div><div class="field-item odd"><a href="/ecg/premature-ventricular-contraction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Premature ventricular contraction</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_2"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fecg-basics-sinus-rhythm-ventricular-bigeminy&amp;title=ECG%20BASICS%3A%20%20Sinus%20Rhythm%20With%20Ventricular%20Bigeminy"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Thu, 09 May 2013 19:20:02 +0000 Dawn 442 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-sinus-rhythm-ventricular-bigeminy#comments Inferolateral M.I. https://www.ecgguru.com/ecg/inferolateral-mi <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/inferolateral-mi"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/IW111A.jpg" width="1800" height="650" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>Unbelievably, this inferolateral ST elevation M.I. was missed by the treating paramedics in the field.&nbsp; An elderly woman stepped off a curb and was hit by a very slow-moving car.&nbsp; She fell and sustained a Colle's fracture of the right wrist. While the paramedics assessed her, she complained of chest pain, prompting them to perform a 12-Lead ECG.&nbsp; The machine's interpretation called attention to the inferior and lateral walls' injury pattern, but the paramedics did not believe it, because "she was a trauma patient". They ran three ECGs, and still did not agree with the machine.</p><p>The patient was transported to a hospital without an interventional cath lab, and she was forced to endure a one-hour wait to be transferred to an appropriate hospital.</p><p>This is a great ECG for a discussion with your students about "distractors".&nbsp; The call came in as a trauma, so that, in itself, was a distractor.&nbsp; The rescuers saw what they expected to see. The angulated fracture distracted them - putting them into full trauma assessment mode.&nbsp; Then, the frequent and coupled PVCs also distracted them, possibly making it more difficult for them to evaluate the ST segments in the normal beats.&nbsp; Interestingly, the second and third ECGs did not have PVCs, and the ST elevation was even more clear.</p><p>PVCs which are repeating themselves in groups of two, three, or more are sinister in a chest pain patient,&nbsp;and may indicate LV dysfunction. They could possibly result in ventricular tachycardia, which would be disasterous for this patient.</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/100/feed" method="post" id="fivestar-custom-widget--3" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--6" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Inferolateral M.I. 1/5</option><option value="40">Give Inferolateral M.I. 2/5</option><option value="60">Give Inferolateral M.I. 3/5</option><option value="80" selected="selected">Give Inferolateral M.I. 4/5</option><option value="100">Give Inferolateral M.I. 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.2</span></span> <span class="total-votes">(<span >5</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--3" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-x58-VJS7zQPn9JRGDykIvP3jYB3kaAwhQ8jqsZ2Z0ss" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/inferior-wall-mi-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Inferior Wall M.I.</a></div><div class="field-item odd"><a href="/ecg/myocardial-infarction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Myocardial infarction</a></div><div class="field-item even"><a href="/ecg/stemi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">STEMI</a></div><div class="field-item odd"><a href="/ecg/pvcs" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">PVCs</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_3"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Finferolateral-mi&amp;title=Inferolateral%20M.I."><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Wed, 26 Sep 2012 22:04:44 +0000 Dawn 342 at https://www.ecgguru.com https://www.ecgguru.com/ecg/inferolateral-mi#comments Sinus Rhythm With Ventricular Bigeminy https://www.ecgguru.com/ecg/sinus-rhythm-ventricular-bigeminy <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/sinus-rhythm-ventricular-bigeminy"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/MR120.png.jpg" width="1800" height="1309" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This is a nice example of sinus rhythm with ventricular bigeminy in a patient with intermittent chest pain and hypertension.&nbsp; The underlying rhythm is most likely normal sinus rhythm, but every other sinus P wave is most likely hidden in the PVCs, and not conducted due to the refractory state of the ventricles after the PVCs.&nbsp; Often, signs of the "hidden" P waves will show in some leads, but that is difficult to demonstrate here.</p> <p>It may be difficult to be sure of an adequate underlying rate, so the PVCs should not be eliminated with antiarrhythmic drugs until there is some ECG sign of a normal underlying rate.</p> <p>Remember, the fourth channel on this ECG is a Lead II rhythm strip.&nbsp; So, if you teach rate and rhythm monitoring, and don't want to use a 12-Lead ECG for your students, simply crop the bottom strip for your class.</p> </div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/100/feed" method="post" id="fivestar-custom-widget--4" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--8" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Sinus Rhythm With Ventricular Bigeminy 1/5</option><option value="40">Give Sinus Rhythm With Ventricular Bigeminy 2/5</option><option value="60">Give Sinus Rhythm With Ventricular Bigeminy 3/5</option><option value="80">Give Sinus Rhythm With Ventricular Bigeminy 4/5</option><option value="100">Give Sinus Rhythm With Ventricular Bigeminy 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="empty">No votes yet</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--4" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-RpoQPuNL8Ad-Afx-I83fJgXMNEl9yFst0SrjLfrM0YI" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/ventricular-bigeminy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ventricular bigeminy</a></div><div class="field-item odd"><a href="/ecg/pvcs" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">PVCs</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_4"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fsinus-rhythm-ventricular-bigeminy&amp;title=Sinus%20Rhythm%20With%20Ventricular%20Bigeminy"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Wed, 19 Sep 2012 21:17:00 +0000 Dawn 333 at https://www.ecgguru.com https://www.ecgguru.com/ecg/sinus-rhythm-ventricular-bigeminy#comments Atrial Flutter With PVCs https://www.ecgguru.com/ecg/atrial-flutter-pvcs <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/atrial-flutter-pvcs"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AFL100.jpg" width="1800" height="987" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This ECG shows a nice, clear atrial flutter with 4:1 conduction.&nbsp; Also, there are frequent PVCs. Good for students who have mastered the criteria for the basic arrythmias and who need to see combinations.&nbsp; That is, PVCs are not only seen with NSR, and it is important to state the <span style="text-decoration: underline;">underlying rhythm</span>.&nbsp; For your more advanced students who understand how to plot frontal plane axis, the axis of the PVCs is nearly straight up - a very strong argument for the ventricular origin of the beats.</p> </div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/100/feed" method="post" id="fivestar-custom-widget--5" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--10" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Atrial Flutter With PVCs 1/5</option><option value="40">Give Atrial Flutter With PVCs 2/5</option><option value="60">Give Atrial Flutter With PVCs 3/5</option><option value="80">Give Atrial Flutter With PVCs 4/5</option><option value="100">Give Atrial Flutter With PVCs 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="empty">No votes yet</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--5" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-Rao7Es2tkLZtl_LKsDIW6prYEckzwEmCjU8EHdXiAo0" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/atrial-flutter-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial flutter</a></div><div class="field-item odd"><a href="/ecg/pvcs" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">PVCs</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_5"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fatrial-flutter-pvcs&amp;title=Atrial%20Flutter%20With%20PVCs"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Mon, 18 Jun 2012 03:48:25 +0000 Dawn 228 at https://www.ecgguru.com https://www.ecgguru.com/ecg/atrial-flutter-pvcs#comments