ECG Guru - Instructor Resources - Wenckebach Conduction https://www.ecgguru.com/ecg/wenckebach-conduction en SECOND DEGREE AVB TYPE I (WENCKEBACH) https://www.ecgguru.com/blog/second-degree-avb-type-i-wenckebach <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/second-degree-avb-type-i-wenckebach"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/guru%201.jpg" width="3205" height="2045" 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>We see the EKG of an 81-year-old patient with a pacemaker; the PM was briefly deactivated to assess the patient's intrinsic heart rhythm. At the beginning of the EKG, there is already a prolonged AV conduction time, which progressively lengthens from beat to beat. The last conducted P-wave has a PR interval of nearly 800 ms (!). The next P-wave is blocked, but the subsequent displayed P-waves are conducted again, with the PR interval increasing from beat to beat. This indicates a classic second degree AVB Type Mobitz I (Wenckebach). The only unusual aspect is the very long AV conduction time.</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/556/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" selected="selected">Give SECOND DEGREE AVB TYPE I (WENCKEBACH) 1/5</option><option value="40">Give SECOND DEGREE AVB TYPE I (WENCKEBACH) 2/5</option><option value="60">Give SECOND DEGREE AVB TYPE I (WENCKEBACH) 3/5</option><option value="80">Give SECOND DEGREE AVB TYPE I (WENCKEBACH) 4/5</option><option value="100">Give SECOND DEGREE AVB TYPE I (WENCKEBACH) 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >1</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" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-CqvXpE5zYdSaznuC9uJXlhRm88k9h-kMehReaqBZs10" /> <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%2Fsecond-degree-avb-type-i-wenckebach&amp;title=SECOND%20DEGREE%20AVB%20TYPE%20I%20%28WENCKEBACH%29"><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> Sat, 05 Aug 2023 09:27:18 +0000 Dr A Röschl 863 at https://www.ecgguru.com https://www.ecgguru.com/blog/second-degree-avb-type-i-wenckebach#comments ECG Challenge: Grouped Beating - Double Tachycardia - ANSWER https://www.ecgguru.com/ecg/ecg-challenge-grouped-beating-double-tachycardia-answer <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-challenge-grouped-beating-double-tachycardia-answer"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/1%20Junctional%20tachycardia.jpg" width="1239" height="202" alt="" /></a></div><div class="field-item odd"><a href="/ecg/ecg-challenge-grouped-beating-double-tachycardia-answer"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/2%20Laddergram.jpg" width="1731" height="344" alt="" /></a></div><div class="field-item even"><a href="/ecg/ecg-challenge-grouped-beating-double-tachycardia-answer"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/3%20Laddergram.jpg" width="1678" height="275" alt="" /></a></div><div class="field-item odd"><a href="/ecg/ecg-challenge-grouped-beating-double-tachycardia-answer"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/4%20Laddergram.jpg" width="1665" height="295" alt="" /></a></div><div class="field-item even"><a href="/ecg/ecg-challenge-grouped-beating-double-tachycardia-answer"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/5%20Laddergram.jpg" width="1357" height="300" 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"><strong>This series of strips was donated by Arnel Carmona, and was taken from a patient admitted to the hospital for a urinary tract infection. &nbsp;No other history is known. &nbsp; On close examination of this rhythm what do we see?</strong></p><p class="MsoNormal"><span style="font-size: 9.0pt;">Strip 1: &nbsp;&nbsp;Narrow-complex tachycardia with NO apparent P waves.</span></p><p class="MsoNormal"><span style="font-size: 9.0pt;">Strip 2: &nbsp;&nbsp;Some irregularity, with long regular groups and still NO P waves.</span></p><p class="MsoNormal"><span style="font-size: 9.0pt;">Strips 3 &amp; 4:&nbsp; Grouped beating.</span></p><p class="MsoNormal"><span style="font-size: 9.0pt;">Strip 5:&nbsp; &nbsp;A narrow-complex rhythm that is approximately ½ the rate of Strip 1.</span><span style="font-size: 13.0080003738403px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">When grouped beating is seen, one should always suspect Wenckebach conduction.&nbsp; Wenckebach conduction (progressively longer conduction times through the A-V conduction system) can occur in rhythyms other than sinus rhythm.&nbsp; Without P waves and PR intervals, GROUPED BEATING is our major clue to Wenckebach conduction.<span style="font-size: 13.0080003738403px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">This patient has an underlying atrial fibrillation – hence no P waves.&nbsp; Fine fibrillatory waves can be seen, but artifact can cause the same appearance.&nbsp; So, why is there no irregular irregularity?&nbsp; There is another rhythm at work here along with the atrial fibrillation.&nbsp; Junctional tachycardia is seen in Strip 1.&nbsp; When two tachycardias coexist, one from above the AV junction, and one from below, the rhythm can be called a “double tachycardia”.&nbsp; This particular combination often happens in patients with digitalis toxicity.<span style="font-size: 9pt; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">In some cases, a complete heart block at the level of the atrial conduction fibers or the AV node causes &nbsp;two rhythms to operate independently.&nbsp; Any supraventricular rhythm, including atrial fib, can occur with a complete heart block, in which case we would see an “escape” rhythm.&nbsp; Escape rhythms are usually slow, either idiojunctional (40-60 bpm) or idioventricular (&lt; 40 bpm).&nbsp;<span style="font-size: 13.0080003738403px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">&nbsp;Let’s look at each of the strips in detail.&nbsp; We will begin with the hypothesis that this is atrial fibrillation with concurrent junctional tachycardia at around 150 bpm.&nbsp; I will include laddergrams to illustrate my view of what is happening.<span style="font-size: 13.0080003738403px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal" style="margin-left: 1.0in; text-indent: -1.0in;"><span style="font-size: 10.0pt;">Strip 1 :&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Junctional tachycardia at around 148-150/min.&nbsp; Differential diagnosis would include sinus tach with 1<sup>st</sup> degree AV block, but we have no evidence in this strip of P waves in the T waves. There is presumably an <strong>entrance block</strong> to the AV node, preventing retrograde P waves from the AV junction from entering the atria.</span></p><p class="MsoNormal" style="margin-left: 1.0in; text-indent: -1.0in;"><span style="font-size: 10.0pt;">Strip 2:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; In this strip, I feel less confident of my hypothesis, but have been able to construct a laddergram that is consistent with a fib and junctional tach with Wenckebach exit block.</span><span style="font-size: 10pt; text-indent: -1in; line-height: 1.538em;">&nbsp; &nbsp; &nbsp;</span><span style="font-size: 10pt; text-indent: -1in; line-height: 1.538em;">I would, as always, welcome input.</span></p><p class="MsoNormal" style="margin-left: 1.0in; text-indent: -1.0in;"><span style="font-size: 10.0pt;">Strip 3:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Now, the grouped beating is very evident.&nbsp; I have mapped out on the laddergram where the beats originate in the AV junction, and where they become a QRS.&nbsp; You can see progressive prolongation in these impulses traveling to the ventricles.&nbsp;&nbsp; There are no P waves because of the atrial fib and the block preventing junctional beats from traveling backward into the atria.</span></p><p class="MsoNormal" style="margin-left: 1.0in; text-indent: -1.0in;"><span style="font-size: 10.0pt;">Strip 4: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; The group beating has taken the form of couplets.&nbsp; The rhythm looks like sinus with PACs, but WAIT …… <strong>no P waves</strong>, remember?</span></p><p class="MsoNormal" style="margin-left: 1.0in; text-indent: -1.0in;"><span style="font-size: 10.0pt;">Strip 5:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Now, the junctional beats are conducting 2:1, and the rate is half what it was in Strip 1, when conduction was 1:1.</span></p><p class="MsoNormal" style="margin-left: 1.0in; text-indent: -1.0in;"><span style="font-size: 10.0pt;">These links may be helpful to you. &nbsp;Discussion of double tachycardia with a fib and junctional tach in <a title="EP Europace Double Tachy" href="http://dx.doi.org/10.1093/europace/eun172">EP Europace</a>. &nbsp;Discussion of atrial fib and Wenckebach in digitalis toxicity by <a title="Grauer Dig Tox A Fib" href="https://www.dropbox.com/s/bga1xtrk33z9nt8/AFib-Wenckebach%20Dig%20Toxicity-Grauer.pdf?dl=0/">Dr. Ken Grauer</a>. &nbsp;Original posting of strips on Arnel Carmona's website, <a title="ECG Rhythms Double Tachy" href="http://wp.me/p4vvFu-jO">ECG Rhythms</a>. &nbsp;These strips are the property of Arnel Carmona and should be used only in an educational context. &nbsp;For any other use, contact <a href="mailto:Dawn.ECGGuru@gmail.com">Dawn.ECGGuru@gmail.com</a>. &nbsp;</span></p><p class="MsoNormal" style="margin-left: 1.0in; text-indent: -1.0in;">&nbsp;<span style="font-size: 13.0080003738403px; line-height: 1.538em;">Thanks so much to Arnel Carmona for this excellent teaching series.&nbsp; We hope you will add your comments and/or questions below.</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/556/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 Challenge: Grouped Beating - Double Tachycardia - ANSWER 1/5</option><option value="40">Give ECG Challenge: Grouped Beating - Double Tachycardia - ANSWER 2/5</option><option value="60">Give ECG Challenge: Grouped Beating - Double Tachycardia - ANSWER 3/5</option><option value="80">Give ECG Challenge: Grouped Beating - Double Tachycardia - ANSWER 4/5</option><option value="100" selected="selected">Give ECG Challenge: Grouped Beating - Double Tachycardia - ANSWER 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.1</span></span> <span class="total-votes">(<span >8</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-JoxWKcyQkWedxNtg_GpkQmOqXRT4wwCrFxLntHqTXBc" /> <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/double-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Double tachycardia</a></div><div class="field-item odd"><a href="/ecg/atrial-fibrillation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial fibrillation</a></div><div class="field-item even"><a href="/ecg/junctional-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Junctional tachycardia</a></div><div class="field-item odd"><a href="/ecg/wenckebach-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wenckebach Conduction</a></div><div class="field-item even"><a href="/ecg/ecg-challenge" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ECG Challenge</a></div><div class="field-item odd"><a href="/ecg/rhythm-strip" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Rhythm strip</a></div><div class="field-item even"><a href="/ecg/wenckebach" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wenckebach</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-challenge-grouped-beating-double-tachycardia-answer&amp;title=ECG%20Challenge%3A%20Grouped%20Beating%20-%20Double%20Tachycardia%20-%20ANSWER"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Wed, 04 Feb 2015 01:06:09 +0000 Dawn 620 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-challenge-grouped-beating-double-tachycardia-answer#comments ECG Challenge: Grouped Beating - Double Tachycardia https://www.ecgguru.com/ecg/ecg-challenge-grouped-beating-double-tachycardia <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-challenge-grouped-beating-double-tachycardia"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Double%20tachycardia%20without%20reference%20laddergram%20from%20another%20source.jpg" width="1710" height="1069" 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 very interesting set of strips was donated to the ECG Guru by Arnel Carmona, well-known to many of you as the Administrator of the blog, "<a href="https://ecgrhythms.wordpress.com/">ECG Rhythms</a>" and the <a title="ECG Guru" href="https://www.facebook.com/pages/ECG-Rhythms/219229508179704">FB page</a> by the same name. &nbsp;He is a frequent contributer to the FB page, "<a title="EKG Club" href="https://www.facebook.com/groups/ekgclub/">EKG Club</a>", and is an ECG Guru! &nbsp;This set of strips was previously posted to his blog and to the EKG Club. &nbsp;In case you haven't already seen it, we will withhold the interpretation for now to give everyone a chance to comment. &nbsp;In one week, we will post the interpretation.</p><p><a title="Double Tachycardia LINK" href="http://ecgguru.com/ecg/ecg-challenge-grouped-beating-double-tachycardia-answer">SEE THE INTERPRETATION AT THIS LINK</a></p><p>*********************************************************************************************</p><p><span style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;">Can Atrial Fibrillation be regular?</span><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><span style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;">This strip is from a pt admitted for UTI.</span><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><span style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;">This cropped lead II strip is from several hours of saved data and specifically posted in order and not necessarily in chronology to highlight a point.</span><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><span style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;">1 - You can see a regular narrow complex tachycardia (NCT) at a rate of about 140’s. How will you read it? SVT? Atrial flutter? AF with RVR? ST with P waves buried in the T waves?</span><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><span style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;">2 - There is still a regular NCT but there is a slowing with no discernible P waves. So AF RVR?</span><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><span style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;">3- The same regular NCT but you can see &nbsp;regularly-irregular QRS activity. Isn’t it that AF should be irregular and will not show any regularity?</span><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><span style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;">4 - There are groups of 2 QRS with same R to R intervals. It is called GROUP BEATING.</span><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><span style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;">5- There is a regular RR interval at a rate of about 70's with no discernible P waves. REGULARIZED AF?</span><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><span style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;">A few interesting things the strip revealed:</span><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><span style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;">1. The fastest rate was about 140's and the regularized rate was about 70's.</span><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><span style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;">2. There is group beating. For beginners, it is hard to see the group beating but probably as you mature or, as you get so crazy and obsessed in looking at strips, &nbsp;then you see it. &nbsp;A few people would and most won't.</span><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><span style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;">Most of us will think, can this be atrial flutter? This is what my other good friends in the ECG Club thought. I checked more than 72 hrs of tele-recordings and could not find the flutter waves. (BTW pt had chronic AF)</span></p><p>What do you think?</p><p><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /><br style="color: #222222; font-family: arial, sans-serif; font-size: 12.7272720336914px; line-height: normal;" /></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/556/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 ECG Challenge: Grouped Beating - Double Tachycardia 1/5</option><option value="40">Give ECG Challenge: Grouped Beating - Double Tachycardia 2/5</option><option value="60">Give ECG Challenge: Grouped Beating - Double Tachycardia 3/5</option><option value="80" selected="selected">Give ECG Challenge: Grouped Beating - Double Tachycardia 4/5</option><option value="100">Give ECG Challenge: Grouped Beating - Double Tachycardia 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.3</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--3" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-NfgYlpyCVxKZyOmcJmunRkv7Hvps9FkTMNGNUB32au4" /> <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/ecg-challenge" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ECG Challenge</a></div><div class="field-item odd"><a href="/ecg/double-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Double tachycardia</a></div><div class="field-item even"><a href="/ecg/atrial-fibrillation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial fibrillation</a></div><div class="field-item odd"><a href="/ecg/junctional-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Junctional tachycardia</a></div><div class="field-item even"><a href="/ecg/wenckebach-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wenckebach Conduction</a></div><div class="field-item odd"><a href="/ecg/rhythm-strip" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Rhythm strip</a></div><div class="field-item even"><a href="/ecg/wenckebach" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wenckebach</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%2Fecg-challenge-grouped-beating-double-tachycardia&amp;title=ECG%20Challenge%3A%20%20Grouped%20Beating%20-%20Double%20Tachycardia"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 25 Jan 2015 23:42:00 +0000 Dawn 615 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-challenge-grouped-beating-double-tachycardia#comments Atrial Flutter With Variable Conduction https://www.ecgguru.com/ecg/atrial-flutter-variable-conduction-1 <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-variable-conduction-1"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AFL%20100%20Atrial%20flutter%20w%20variable%20cond.jpg" width="1800" height="1485" alt="" /></a></div><div class="field-item odd"><a href="/ecg/atrial-flutter-variable-conduction-1"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AFL%20100%20Atrial%20flutter%20w%20variable%20cond%20beats%20numbered.jpg" width="1800" height="1485" 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 provides an example of atrial flutter with variable conduction. &nbsp;There are two distinct R - R intervals, making this a somewhat <strong>regularly-irregular</strong> &nbsp;rhythm, as opposed to the irregular irregularity of atrial fibrillation. &nbsp;The flutter waves (P waves) are very easy to see in most leads, but not in all. &nbsp;If you are teaching students who are making the transition from reading monitors and rhythm strips to 12-lead ECGs, this is a great ECG to illustrate for them how the more leads you have, the more you will see. &nbsp;The flutter waves are invisible in Lead I and, to the untrained eye, they may be hard to see in the precordial leads. &nbsp;The four channels on this ECG are run simultaneously, so if &nbsp;P waves or flutter waves are visible in one lead, they are also present in all leads that line up vertically with that one. &nbsp;In other words, the Lead II rhythm strip at the bottom confirms that flutter waves exist across the entire ECG.</p><p>The R - R intervals in this ECG reflect alternating 2:1 and 4:1 conduction. &nbsp;There are a couple of times when the 4:1 ratio repeats itself without alternating. &nbsp;Often, the length of these varying R - R intervals will be multiples of each other, or have a common denominator. &nbsp;These do not appear to, and may reflect the fact that, when R to P intervals lengthen, R to R intervals sometimes shorten. &nbsp;In other words, the PR intervals, which are difficult to measure in atrial flutter, may be changing. &nbsp;I would invite my colleagues with more expertise in this area to comment below.</p><p>There are no blatant ST segment abnormalities here, but ST segments can be very difficult to assess in atrial flutter because of the flutter waves. &nbsp;We do not have clinical data, other than this is a 62-year-old 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/556/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 Atrial Flutter With Variable Conduction 1/5</option><option value="40">Give Atrial Flutter With Variable Conduction 2/5</option><option value="60">Give Atrial Flutter With Variable Conduction 3/5</option><option value="80" selected="selected">Give Atrial Flutter With Variable Conduction 4/5</option><option value="100">Give Atrial Flutter With Variable Conduction 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.4</span></span> <span class="total-votes">(<span >52</span> votes)</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-qlgWzM9-OiwtfaCYlpzp1mo5S6YqMBrbO4-w8pCArrI" /> <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/tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Tachycardia</a></div><div class="field-item even"><a href="/ecg/wenckebach-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wenckebach Conduction</a></div><div class="field-item odd"><a href="/ecg/grouped-beating" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Grouped beating</a></div><div class="field-item even"><a href="/ecg/atrial-flutter-ariable-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial flutter with ariable conduction</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%2Fatrial-flutter-variable-conduction-1&amp;title=Atrial%20Flutter%20With%20Variable%20Conduction"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Tue, 04 Nov 2014 06:24:57 +0000 Dawn 604 at https://www.ecgguru.com https://www.ecgguru.com/ecg/atrial-flutter-variable-conduction-1#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/556/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-6GA81X1ugbdzo2Q3XpdqTY66q1U8w_Mg5IPrIvyxVTg" /> <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