ECG Guru - Instructor Resources - Wenckebach periodicity https://www.ecgguru.com/ecg/wenckebach-periodicity en Jason's Blog: ECG Challenge for the month of January, 2014. https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-month-january-2014 <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/jasons-blog-ecg-challenge-month-january-2014"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Month%202u%20laddergram.png" width="782" height="519" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p><strong><span style="text-decoration: underline;">Patient data:</span></strong>&nbsp; 64-year old man who, prior to this ECG, had been in normal sinus rhythm.&nbsp; Whatever your level of sophistication in rhythm interpretation (i.e., basic, intermediate, or advanced), this ECG has a little bit of something for everybody.&nbsp; Basic interpreters will undoubtedly recognize the dominant disturbance of rhythm.&nbsp; Intermediate interpreters will probably add more descriptors to their interpretation that will better describe the overall pattern.&nbsp; Advanced interpreters will recognize the unique nature of multilevel conduction and ratios.&nbsp; A laddergram will best elucidate the exact mechanism.&nbsp; I'd like to hear from all types of interpreters. <img title="Laughing" src="http://ecgguru.com/sites/all/libraries/tinymce/jscripts/tiny_mce/plugins/emotions/img/smiley-laughing.gif" alt="Laughing" border="0"></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/150/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 Jason&amp;#039;s Blog: ECG Challenge for the month of January, 2014. 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge for the month of January, 2014. 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge for the month of January, 2014. 3/5</option><option value="80" selected="selected">Give Jason&amp;#039;s Blog: ECG Challenge for the month of January, 2014. 4/5</option><option value="100">Give Jason&amp;#039;s Blog: ECG Challenge for the month of January, 2014. 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.7</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" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-bzr1mTFPhezj6u6I3C3uAZlGMH_Xx94PaWfA4XxFF-E" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></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%2Fblog%2Fjasons-blog-ecg-challenge-month-january-2014&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20for%20the%20month%20of%20January%2C%202014."><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> Sun, 29 Dec 2013 15:52:09 +0000 jer5150 536 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-month-january-2014#comments Jason's Blog: ECG Challenge of the Week for March 24th - 31st. https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-march-24th-31st <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/jasons-blog-ecg-challenge-week-march-24th-31st"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%202k%20ladder.png" width="765" height="499" alt="" /></a></div><div class="field-item odd"><a href="/blog/jasons-blog-ecg-challenge-week-march-24th-31st"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%202k%20supplimental.png" width="765" height="417" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p><span style="text-decoration: underline;"><strong>Patient's clinical data:</strong></span>&nbsp; 47-year-old black man.&nbsp; Another serial ECG (seen below) showed a supraventricular tachycardia (SVT) at a rate of 164/min that was diagnosed by an Electrophysiologist as <a href="http://www.ekgguru.com/ecg/atrioventricular-nodal-reentrant-tachycardia" target="_blank">atrioventricular nodal reentrant tachycardia (AVNRT)</a>.&nbsp; How does knowing the mechanism of AVNRT help you in determining the nature of the mechanism in this week's ECG. &nbsp; <br><br>This shares some similarities with previous ECGs that I've posted but this time there is an extra twist. <br><br>Is this really what it appears to be?&nbsp; Well, . . . yes <em>and</em> no.&nbsp; It depends on whether you're referring to how it manifests electrocardiographically on the surface tracing OR electrophysiologically on a cellular level.&nbsp; Don't make the mistake of rushing to make a hasty judgement and be sure to pay attention to subtle detail.&nbsp; As usual, a heavily detailed laddergram will reveal all!&nbsp;</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/150/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 Jason&amp;#039;s Blog: ECG Challenge of the Week for March 24th - 31st. 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for March 24th - 31st. 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for March 24th - 31st. 3/5</option><option value="80">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for March 24th - 31st. 4/5</option><option value="100" selected="selected">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for March 24th - 31st. 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.2</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-CoPiD8VkwxbptxrKvTcjWNt6te9Ou5YzqIRTOiRznlQ" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></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%2Fblog%2Fjasons-blog-ecg-challenge-week-march-24th-31st&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20of%20the%20Week%20for%20March%2024th%20-%2031st."><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sat, 23 Mar 2013 14:08:31 +0000 jer5150 422 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-march-24th-31st#comments Jason's Blog: ECG Challenge of the Week for Feb. 10th - 17th. https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-feb-10th-17th <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/jasons-blog-ecg-challenge-week-feb-10th-17th"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%202e%20ladder.png" width="765" height="509" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p><span style="text-decoration: underline;"><strong>Patient's clinical data:</strong></span>&nbsp; 84-year-old black man</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/150/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 Jason&amp;#039;s Blog: ECG Challenge of the Week for Feb. 10th - 17th. 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Feb. 10th - 17th. 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Feb. 10th - 17th. 3/5</option><option value="80">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Feb. 10th - 17th. 4/5</option><option value="100" selected="selected">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Feb. 10th - 17th. 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >5</span></span> <span class="total-votes">(<span >1</span> vote)</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-nqa5kKrgqCinBaLGvUXW3QjLeccsdb79wd5CdJM47mY" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></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%2Fblog%2Fjasons-blog-ecg-challenge-week-feb-10th-17th&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20of%20the%20Week%20for%20Feb.%2010th%20-%2017th."><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sat, 09 Feb 2013 23:59:17 +0000 jer5150 400 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-feb-10th-17th#comments Jason's Blog: ECG Challenge of the Week for Jan. 13th - 20th. https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-jan-13th-20th <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/jasons-blog-ecg-challenge-week-jan-13th-20th"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%202b%20ladder.png" width="765" height="551" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p><span style="text-decoration: underline;"><strong>Patient's clinical data:</strong></span>&nbsp; 46-year-old black man <br><br>The computer's interpretation was "undetermined rhythm".&nbsp; <br><br>What is the source and mechanism of this rhythm?</p> <p>&nbsp;</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/150/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 Jason&amp;#039;s Blog: ECG Challenge of the Week for Jan. 13th - 20th. 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Jan. 13th - 20th. 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Jan. 13th - 20th. 3/5</option><option value="80">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Jan. 13th - 20th. 4/5</option><option value="100">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Jan. 13th - 20th. 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-2UziUJ1fQRPhWr60iNiw8J_Hg5_5kowka2TaezFfqxs" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></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%2Fblog%2Fjasons-blog-ecg-challenge-week-jan-13th-20th&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20of%20the%20Week%20for%20Jan.%2013th%20-%2020th."><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 13 Jan 2013 16:12:28 +0000 jer5150 392 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-jan-13th-20th#comments Jason's Blog: ECG Challenge of the Week for Jan. 6th - 13th. https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-jan-6th-13th <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/jasons-blog-ecg-challenge-week-jan-6th-13th"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week2a%20ladder.png" width="765" height="505" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>This ECG was taken from an 87-year-old black man and was diagnosed by the reviewing cardiologist as "complete AV block". <br><br>Is that really the interpretation or is it something else?</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/150/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 Jason&amp;#039;s Blog: ECG Challenge of the Week for Jan. 6th - 13th. 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Jan. 6th - 13th. 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Jan. 6th - 13th. 3/5</option><option value="80" selected="selected">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Jan. 6th - 13th. 4/5</option><option value="100">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Jan. 6th - 13th. 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4</span></span> <span class="total-votes">(<span >1</span> vote)</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-7VzVRy1vwAEE8cfj8E1wSqAG6ZJF3TtuoUQYAelrl6k" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></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%2Fblog%2Fjasons-blog-ecg-challenge-week-jan-6th-13th&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20of%20the%20Week%20for%20Jan.%206th%20-%2013th."><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Mon, 07 Jan 2013 01:03:50 +0000 jer5150 390 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-jan-6th-13th#comments Jason's Blog: ECG Challenge of the Week for Oct. 14-21. What does this tracing show? https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-oct-14-21-what-does-tracing-show <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/jasons-blog-ecg-challenge-week-oct-14-21-what-does-tracing-show"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201q%20answer.png" width="765" height="509" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>&nbsp;</p> <p class="MsoNormal" style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; line-height: normal;"><span style="font-size: 12.0pt; font-family: 'Times New Roman','serif'; mso-fareast-font-family: 'Times New Roman';">A member’s recent comment inspired me to post this ECG.<span style="mso-spacerun: yes;">&nbsp; </span>I’ve chosen this topic because there is much confusion and misunderstanding about it. <span style="mso-spacerun: yes;">&nbsp;</span><span style="mso-spacerun: yes;">&nbsp;&nbsp;</span><span style="mso-spacerun: yes;">&nbsp;</span><br><br>Beginning with this ECG of the Week, I’m going to start routinely presenting these as multiple choices in order to try and encourage more active participation from ECG Guru members.<span style="mso-spacerun: yes;">&nbsp; </span>I copied the idea from one of Dr. Wang’s ECGs that was posted on Medscape 8 years ago.<br><br>This was one of five consecutive ECGs that I performed on a patient a month or two ago.<span style="mso-spacerun: yes;">&nbsp; </span><br><br><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;">Patient’s clinical data:</span></strong> <span style="mso-spacerun: yes;">&nbsp;</span>68-year-old white man with unremarkable cardiac history.<span style="mso-spacerun: yes;">&nbsp; </span>After his primary care provider (PCP) detected a slow and irregular pulse on this patient, she sent him over to me, in the Outpatient EKG Lab, to perform a “routine” 12-lead ECG.<br><br><em style="mso-bidi-font-style: normal;">Pick the answer that you feel best describes what is seen in the ECG above:</em> <span style="mso-spacerun: yes;">&nbsp;&nbsp;</span><br><br>(1.)<span style="mso-spacerun: yes;">&nbsp; </span>Starts out as Type II, converts to Type I, and then reverts back to type II AV block<br>(2.)<span style="mso-spacerun: yes;">&nbsp; </span>Type I AV block all throughout <br>(3.)<span style="mso-spacerun: yes;">&nbsp; </span>Type II AV block all throughout <span style="mso-spacerun: yes;">&nbsp;</span><br>(4.)<span style="mso-spacerun: yes;">&nbsp; </span>Neither Type I nor Type II, but a genre all its own<br>(5.)<span style="mso-spacerun: yes;">&nbsp; </span>This may be Type I or Type II, but you cannot tell which one it is</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/150/feed" method="post" id="fivestar-custom-widget--6" 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--12" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Oct. 14-21. What does this tracing show? 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Oct. 14-21. What does this tracing show? 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Oct. 14-21. What does this tracing show? 3/5</option><option value="80">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Oct. 14-21. What does this tracing show? 4/5</option><option value="100" selected="selected">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for Oct. 14-21. What does this tracing show? 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >5</span></span> <span class="total-votes">(<span >1</span> vote)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--6" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-ijcoafKpH1kKAnoHR6F_cxEmjXJKNAYoLE6FS7_-njo" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_6"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fblog%2Fjasons-blog-ecg-challenge-week-oct-14-21-what-does-tracing-show&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20of%20the%20Week%20for%20Oct.%2014-21.%20%20What%20does%20this%20tracing%20show%3F"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sat, 13 Oct 2012 23:20:21 +0000 jer5150 348 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-oct-14-21-what-does-tracing-show#comments LYME DISEASE CAUSING AV BLOCK https://www.ecgguru.com/blog/lyme-disease-causing-av-block <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/lyme-disease-causing-av-block"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Lyme%20Disease%201.png" width="782" height="508" alt="" /></a></div><div class="field-item odd"><a href="/blog/lyme-disease-causing-av-block"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Lyme%20Disease%202.png" width="765" height="525" alt="" /></a></div><div class="field-item even"><a href="/blog/lyme-disease-causing-av-block"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Lyme%20Disease%203.png" width="583" height="757" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p><span style="font-size: 12.0pt; line-height: 115%; font-family: 'Calibri','sans-serif'; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">We are now in the month of August. Lyme Disease Awareness Month was about 4 months ago in May but that doesn’t mean that the number of cases are in decline.&nbsp; As a result of the mild winter, deer populations are thriving and consequently deer ticks are booming.&nbsp; &nbsp; <br><br>Since I’ve already posted my answer to this week’s ECG Challenge, I thought I’d take this opportunity to issue a pertinent and timely public health/practice alert.<span style="mso-spacerun: yes;">&nbsp; </span><br><br>This particularly applies to those of you who live in <a href="http://commonhealth.wbur.org/2012/02/ultimate-lyme-disease-map"><span style="font-weight: normal;">“at risk” states.</span></a>&nbsp; Virginia itself is not considered a high risk state, but it certainly shares borders with states that are.&nbsp; Transitional zones extend well into the Central Virginia area where&nbsp;I live.&nbsp; <br><br>If you’re a healthcare provider who performs ECGs and/or conducts an initial review of them, then you should be on the lookout for the onset of any newly documented A-V blocks in your patient population.<span style="mso-spacerun: yes;">&nbsp; </span>On my daily job, I often find myself in the unique position of being the first person to discover changes in rhythm, rate, and/or waveforms.<span style="mso-spacerun: yes;">&nbsp; </span>You should be hypersensitive to the symptoms of Lyme disease and keep it on your diagnostic “radar”.<span style="mso-spacerun: yes;">&nbsp; Recently, I featured two examples of <a href="http://www.ekgguru.com/content/jasons-blog-ecg-challenge-week-july-22-29-what-are-causes-these-patterns" target="_blank">AV block</a> with one of them being new.&nbsp; In retrospect, I should have <em>suggested</em> Lyme disease to both of the doctors when I returned the ECGs back to them. &nbsp;</span>I, and some of my fellow cardiographic technicians, have noticed an increase of patients coming in with ticks embedded in their skin.<span style="mso-spacerun: yes;">&nbsp; </span>One of my coworkers said she discovered two ticks on the same patient during the course of performing their resting ECG.&nbsp; <span style="mso-spacerun: yes;">In order to properly perform an ECG, a certain amount of undress, disrobing, and skin exposure is mandatory.&nbsp; Just as hairdressers have been trained to recognize skin cancer on the scalp, I've been putting the word out for others to be on the lookout for ticks and/or suspicious rashes when performing ECGs.&nbsp; </span><span style="mso-spacerun: yes;">&nbsp;&nbsp;</span><br><br>Suspecting Lyme disease is especially true if you discover relatively young and otherwise healthy individuals exhibiting disproportionately <a href="http://www.ekgguru.com/content/sinus-tachycardia-high-grade-av-block" target="_blank">high-grade (advanced) AV blocks</a> such as the one I’ve posted above.&nbsp; It's probably safe to say that most medical professionals don't know that Lyme disease can cause atrioventricular (AV) blocks.&nbsp; In talking to my colleagues in cardiology, I've found out that a fair amount of them didn't know this fact.&nbsp; Lyme disease doesn't always lead to A-V block (only about 8% of cases do), but when left untreated, it increases the risk that it&nbsp;might progress to high-grade or even complete AV block which can&nbsp;contribute to death.&nbsp; <br><br></span><strong><span style="text-decoration: underline;"><span style="font-size: 12pt; line-height: 115%; font-family: 'Calibri','sans-serif';">Patient’s clinical data:</span></span></strong><span style="font-size: 12.0pt; line-height: 115%; font-family: 'Calibri','sans-serif'; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;"> <span style="mso-spacerun: yes;">&nbsp;</span>31-year-old black man who reported recent rash 5-6 weeks prior to hospital visit.<span style="mso-spacerun: yes;">&nbsp; </span>Lyme titer came back positive at a level of 5.33.<span style="mso-spacerun: yes;">&nbsp; </span>Any level greater than 1.09 is considered to be positive.<span style="mso-spacerun: yes;">&nbsp; </span>During his hospitalization, this patient was reported to have a 9-second period of ventricular asystole for which he received a temporary pacemaker. <br><br>Personally, I’ve been a long-time resident of the Commonwealth of Virginia for over 31 years, and recently I’ve noticed an increase in stories being run by the local news media on both television and in print.</span><br style="mso-spacerun: yes;"><br><strong><span style="text-decoration: underline;"><span style="font-size: 12pt; line-height: 115%; font-family: 'Calibri','sans-serif';">Sources / References:</span></span></strong><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; line-height: 115%; font-family: 'Calibri','sans-serif'; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;"> <br></span></strong><span style="font-size: 12.0pt; line-height: 115%; font-family: 'Calibri','sans-serif'; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">(1.)</span><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; line-height: 115%; font-family: 'Calibri','sans-serif'; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">&nbsp; </span></strong><a href="http://www.nbc12.com/story/14642482/lyme-disease" target="_blank"><span style="font-size: 12.0pt; line-height: 115%; font-family: 'Calibri','sans-serif'; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">Governor warns of Lyme disease as tick season continues</span></a><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; line-height: 115%; font-family: 'Calibri','sans-serif'; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;"><br></span></strong><span style="font-size: 12.0pt; line-height: 115%; font-family: 'Calibri','sans-serif'; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">(2.)</span><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; line-height: 115%; font-family: 'Calibri','sans-serif'; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">&nbsp; </span></strong><span style="font-size: small; font-family: arial,helvetica,sans-serif;"><a href="http://reference.medscape.com/features/slideshow/skin-patches?src=emed_case_nl_0" target="_blank"><span style="text-decoration: none; color: #1171a7;">Strange Skin Patches with Syncope and Palpitations</span></a></span> (sign-in required)<br><span style="font-size: 12.0pt; line-height: 115%; font-family: 'Calibri','sans-serif'; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">(3.)</span><span style="font-size: 12.0pt; line-height: 115%; font-family: 'Calibri','sans-serif'; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;"><span style="mso-spacerun: yes;">&nbsp;</span><strong style="mso-bidi-font-weight: normal;"><a href="http://www2.timesdispatch.com/news/2011/may/07/tdmet03-lyme-disease-on-rise-in-virginia-health-of-ar-1022790/"><span style="font-weight: normal;">Lyme disease on rise in Virginia, health officials say</span></a><br></strong></span><span style="font-size: 12.0pt; line-height: 115%; font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">(4.)</span><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; line-height: 115%; font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;"><span style="mso-spacerun: yes;">&nbsp; </span><a href="http://wtvr.com/2012/05/16/ticks-are-out-and-lymes-disease-is-increasing/"><span style="font-weight: normal;">Ticks are out and Lyme disease is&nbsp;increasing</span></a></span></strong><a href="http://wtvr.com/2012/05/16/ticks-are-out-and-lymes-disease-is-increasing/"><br></a></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/150/feed" method="post" id="fivestar-custom-widget--7" 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--14" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give LYME DISEASE CAUSING AV BLOCK 1/5</option><option value="40">Give LYME DISEASE CAUSING AV BLOCK 2/5</option><option value="60">Give LYME DISEASE CAUSING AV BLOCK 3/5</option><option value="80" selected="selected">Give LYME DISEASE CAUSING AV BLOCK 4/5</option><option value="100">Give LYME DISEASE CAUSING AV BLOCK 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4</span></span> <span class="total-votes">(<span >2</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--7" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-GjNrjvlmEVV6HBWSLOAP1BJn_B6ApCtd1cdYG7e870I" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_7"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fblog%2Flyme-disease-causing-av-block&amp;title=LYME%20DISEASE%20CAUSING%20AV%20BLOCK"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Thu, 02 Aug 2012 02:11:42 +0000 jer5150 278 at https://www.ecgguru.com https://www.ecgguru.com/blog/lyme-disease-causing-av-block#comments Jason's Blog: ECG Challenge of the Week for July 22-29. What are the causes of these patterns? https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-july-22-29-what-are-causes-these-patterns <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/jasons-blog-ecg-challenge-week-july-22-29-what-are-causes-these-patterns"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201e-1a%20answer.png" width="765" height="509" alt="" /></a></div><div class="field-item odd"><a href="/blog/jasons-blog-ecg-challenge-week-july-22-29-what-are-causes-these-patterns"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201e-2a%20answer.png" width="765" height="644" alt="" /></a></div><div class="field-item even"><a href="/blog/jasons-blog-ecg-challenge-week-july-22-29-what-are-causes-these-patterns"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201e-2b%20answer.png" width="765" height="631" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>&nbsp;</p> <p><span style="font-size: small;">I recently performed both of these ECGs a few days apart during the same work week.&nbsp; They were recorded on an outpatient basis.&nbsp; It wasn’t until I recorded the second ECG that I realized I had a good pair of ECGs to illustrate this comparison.</span><br><br><span style="font-size: small;">At a superficial glance, both of these appear to represent the same thing and some people&nbsp;might even argue that both of these ECGs have identical interpretations but they would be wrong.&nbsp; One of these represents a conventional example that is <em>intrinsic</em> to the heart and it's conduction system.&nbsp; The other is a lesser-known example and is <em>extrinsic</em> to the heart.&nbsp; Admittedly, they do share similar characteristics however there are several contrasting features as well.<span class="MsoNormal">&nbsp;</span> </span><br><br><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;"><span style="color: blue;">Fig. # 1</span></span></strong> </span><br><br><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;"><span style="color: #c00000;">Patient's clinical data:</span></span></strong> &nbsp;68-year-old white man.&nbsp; </span><span style="font-size: small;">History of hypertension.</span><br class="MsoNormal"><br><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;"><span style="color: blue;">Fig. # 2</span></span></strong></span><br><br><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;"><span style="color: #c00000;">Patient's clinical data:</span></span></strong>&nbsp; 57-year-old black man. </span><br><br><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;">The computer interpreted <span style="color: blue;">Fig. # 2</span> as:</span></strong></span></p> <table class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-yfti-tbllook: 1184; mso-padding-alt: 0in 5.4pt 0in 5.4pt;" border="1" cellspacing="0" cellpadding="0"> <tbody> <tr style="mso-yfti-irow: 0; mso-yfti-firstrow: yes; mso-yfti-lastrow: yes;"> <td style="width: 6.65in; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top" width="638"> <p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: small;">Marked sinus bradycardia with marked sinus arrhythmia 1st degree AV block</span><br><span style="font-size: small;">Voltage criteria for left ventricular hypertrophy</span><br><span style="font-size: small;">Abnormal ECG</span><br><span style="font-size: small;">When compared with ECG of <em style="mso-bidi-font-style: normal;">(deleted)</em></span><br><span style="font-size: small;">PR interval has increased</span></p> </td> </tr> </tbody> </table> <p class="MsoNormal"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;">DO YOU AGREE WITH THE COMPUTER?</strong></span><br><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;"><span style="line-height: 115%; color: #009900;"><br>QUESTIONS:</span></span></strong>&nbsp; </span></p> <p><span style="font-size: small;"><span style="line-height: 115%;">What are the causes of the pauses and the "group beating"?&nbsp; Do either of these patients need a pacemaker?</span>&nbsp;<span style="line-height: 115%;"> <br><br><span style="text-decoration: underline;"><strong>Hint:</strong></span>&nbsp; In <span style="color: blue;">Fig. # 2</span>, pay careful attention to the sinus P-P intervals and their correlation with the timing of the pauses.&nbsp; Compare the <em style="mso-bidi-font-style: normal;">PR intervals</em> and their corresponding <em>RP intervals</em>.&nbsp; Also contrast the lengths of the longest and shortest RR intervals. &nbsp;This will help to differentiate it from <span style="color: blue;">Fig. # 1</span>.</span></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/150/feed" method="post" id="fivestar-custom-widget--8" 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--16" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for July 22-29. What are the causes of these patterns? 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for July 22-29. What are the causes of these patterns? 2/5</option><option value="60" selected="selected">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for July 22-29. What are the causes of these patterns? 3/5</option><option value="80">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for July 22-29. What are the causes of these patterns? 4/5</option><option value="100">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for July 22-29. What are the causes of these patterns? 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >2.7</span></span> <span class="total-votes">(<span >3</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--8" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-6Bxk8hUNJULpbY9eIUc9lqMAgdcgHGr5r1Vo9h-N_Ek" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_8"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fblog%2Fjasons-blog-ecg-challenge-week-july-22-29-what-are-causes-these-patterns&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20of%20the%20Week%20for%20July%2022-29.%20%20What%20are%20the%20causes%20of%20these%20patterns%3F"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 22 Jul 2012 05:09:42 +0000 jer5150 253 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-july-22-29-what-are-causes-these-patterns#comments