ECG Guru - Instructor Resources - Left ventricular hypertrophy https://www.ecgguru.com/ecg/left-ventricular-hypertrophy en Left Bundle Branch Block With Left Ventricular Hypertrophy https://www.ecgguru.com/ecg/left-bundle-branch-block-left-ventricular-hypertrophy <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/left-bundle-branch-block-left-ventricular-hypertrophy"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/LB%20112.jpg" width="1800" height="1308" 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 92-year-old patient was diagnosed with left bundle branch block on ECG, and left ventricular hypertrophy on echocardiogram.&nbsp; The two conditions are very often seen together, in fact, a majority of LBBB patients have LVH.&nbsp; Since the two conditions&nbsp;can have similar ECG changes, it is difficult from the ECG alone to determine the presence of LVH when LBBB is present.&nbsp; If the ECG criteria for LVH are present,&nbsp;it can be assumed that LVH is present, even in the presence of LBBB.&nbsp; For determining LVH by ECG criteria, the Sokolov-Lyon criteria are commonly used ( S wave in V1 + R wave in V5 or V6&nbsp;&gt; 35 mm).&nbsp;</p><p>The common criteria for left bundle branch block include:&nbsp; wide QRS complex, frontal plane axis normal or leftward, negative QRS in V1, and positive QRS in leads I and V6.&nbsp;&nbsp;&nbsp;LBBB is only found in supraventricular rhythms (not ventricular rhythms).&nbsp; The ST segment and T wave will be negative in leads with positive QRS complexes, and positive in leads with negative QRSs (discordant).</p><p>Left ventricular hypertrophy also widens the QRS, although not often as much as LBBB does.&nbsp; There will be discordant ST segments and T waves, which is called the "strain" pattern.&nbsp; It also is&nbsp;easier to diagnose in supraventricular rhythms, because ventricular rhythms usually have large QRS complexes due to the depolarization wave being in one direction across the heart.</p><p>For confirmation of LVH, an echocardiogram is recommended.</p><p>This ECG also has an interesting rhythm.&nbsp; The first beat appears normal, the second beat is a PAC.&nbsp; The third beat appears to arise from a different focus, which would make it an escape beat, but it is very difficult to determine this due to the very tiny P waves.&nbsp; After a pause, a regular sinus rhythm resumes.&nbsp; To see the P waves, look at the right chest leads:&nbsp; V1, V2, V3.&nbsp; Since left bundle branch block only occurs in SUPRAVENTRICULAR rhythms, it is important to determine the rhythm, and P waves are a definite sign of SV rhythm.&nbsp; We wish the P waves here were taller.</p><p>References:&nbsp; <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC482258/"><span style="text-decoration: underline;"><span style="color: #0066cc;">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC482258/</span></span></a>,&nbsp; <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC482000/"><span style="text-decoration: underline;"><span style="color: #0066cc;">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC482000/</span></span></a>, <a href="http://journal.publications.chestnet.org/article.aspx?articleid=1058580"><span style="text-decoration: underline;"><span style="color: #0066cc;">http://journal.publications.chestnet.org/article.aspx?articleid=1058580</span></span></a>, <a href="http://lifeinthefastlane.com/ecg-library/basics/left-ventricular-hypertrophy/"><span style="text-decoration: underline;"><span style="color: #0066cc;">http://lifeinthefastlane.com/ecg-library/basics/left-ventricular-hypertrophy/</span></span></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/91/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 Left Bundle Branch Block With Left Ventricular Hypertrophy 1/5</option><option value="40">Give Left Bundle Branch Block With Left Ventricular Hypertrophy 2/5</option><option value="60">Give Left Bundle Branch Block With Left Ventricular Hypertrophy 3/5</option><option value="80" selected="selected">Give Left Bundle Branch Block With Left Ventricular Hypertrophy 4/5</option><option value="100">Give Left Bundle Branch Block With Left Ventricular Hypertrophy 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 >11</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-xoKWr8sraRmh_0G_0gzdX30-G0BcUSo0A9iaLiMauDs" /> <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/left-bundle-branch-block-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left bundle branch block</a></div><div class="field-item odd"><a href="/ecg/left-ventricular-hypertrophy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left ventricular hypertrophy</a></div><div class="field-item even"><a href="/ecg/pac" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">PAC</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%2Fleft-bundle-branch-block-left-ventricular-hypertrophy&amp;title=%20Left%20Bundle%20Branch%20Block%20With%20Left%20Ventricular%20Hypertrophy"><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> Wed, 21 Sep 2016 05:14:20 +0000 Dawn 453 at https://www.ecgguru.com https://www.ecgguru.com/ecg/left-bundle-branch-block-left-ventricular-hypertrophy#comments Deep, Symmetrical T Wave Inversions https://www.ecgguru.com/ecg/deep-symmetrical-t-wave-inversions <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/deep-symmetrical-t-wave-inversions"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/T%20wave%20inversions.jpg" width="1800" height="614" 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">This ECG is from a 50-year-old man with chest pain.&nbsp; Unfortunately, we don’t have any other clinical information.&nbsp;&nbsp; This tracing is a good example of widespread, symmetrical inverted T waves.&nbsp; Inverted T waves are present in Leads I, aVL, II, and V3 through V6. (The anterior-lateral leads).&nbsp; There are ST segment elevations in Leads V1 and V2.&nbsp;<span style="font-size: 8pt; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">Many conditions can cause inverted T waves, and bedside assessment is necessary to make a certain diagnosis.&nbsp; Some T wave inversions are benign, such as in persistent juvenile T wave pattern.&nbsp; Some can be due to life-threatening problems like pulmonary embolism, CNS injury, and cardiac ischemia.&nbsp; T wave inversions can be secondary to conditions like left ventricular hypertrophy, left bundle branch block, and ventricular rhythms.&nbsp; When T waves are deep and symmetrical as they are here, they may be a sign of acute coronary syndrome, or cardiac ischemia.&nbsp; Since we know this patient had chest pain, and there is some ST elevation, this should be considered as a cause for his T wave changes.<span style="font-size: 8pt; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">In addition to the dramatic T waves, he also has P waves suggestive of “P mitrale”, or left atrial enlargement.&nbsp; The P waves in Lead II are wide (about 10 or 11 ms) and just over 1 mv tall. This is “borderline” for most <a href="http://lifeinthefastlane.com/ecg-library/basics/left-atrial-enlargement/">LAE criteria</a>. &nbsp;&nbsp;The P waves in Lead V1 are biphasic, with the second portion negatively deflected and over 1 mv deep.&nbsp; Acute myocardial infarction can cause left ventricular dysfunction, which can cause backup pressure to the left atrium.<span style="font-size: 8pt; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">Inverted T waves, like all ST and T wave changes, should always be assessed in the context of the patient presentation, history, and previous ECGs, if available.<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p><span style="font-size: 11.0pt; 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;">References:&nbsp; <a href="http://www.consultantlive.com/cardiovascular-diseases/inverted-t-wave-differential-diagnosis-adult-patient">Consultantlive.com, </a>&nbsp;&nbsp;<a href="http://ecg-interpretation.blogspot.com/2013/01/ecg-interpretation-review-59-t-wave.html">Dr. Ken Grauer</a> </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/91/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 Deep, Symmetrical T Wave Inversions 1/5</option><option value="40">Give Deep, Symmetrical T Wave Inversions 2/5</option><option value="60">Give Deep, Symmetrical T Wave Inversions 3/5</option><option value="80" selected="selected">Give Deep, Symmetrical T Wave Inversions 4/5</option><option value="100">Give Deep, Symmetrical T Wave Inversions 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 >5</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-Gu_DSTYLAff_HIbRT9Xni3TKSMkyM_nn42C71tkEOZY" /> <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/t-wave-inversion" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">T Wave Inversion</a></div><div class="field-item odd"><a href="/ecg/ischemia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ischemia</a></div><div class="field-item even"><a href="/ecg/coronary-syndrome" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Coronary syndrome</a></div><div class="field-item odd"><a href="/ecg/giant-t-waves" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Giant T waves</a></div><div class="field-item even"><a href="/ecg/left-ventricular-hypertrophy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left ventricular hypertrophy</a></div><div class="field-item odd"><a href="/ecg/coronary-artery-disease-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Coronary artery disease</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%2Fdeep-symmetrical-t-wave-inversions&amp;title=Deep%2C%20Symmetrical%20T%20Wave%20Inversions"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Wed, 16 Dec 2015 03:20:58 +0000 Dawn 680 at https://www.ecgguru.com https://www.ecgguru.com/ecg/deep-symmetrical-t-wave-inversions#comments Inverted T waves in Lateral Wall https://www.ecgguru.com/ecg/inverted-t-waves-lateral-wall <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/inverted-t-waves-lateral-wall"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/CAD108.jpg" width="1800" height="1317" 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 was obtained from a 49-year-old man who was a patient in an Emergency Dept. &nbsp;We do not know his presenting complaint, only that he had a history of insulin-dependent diabetes mellitus (IDDM). &nbsp;It was noted by the donor of the ECG that the patient had no chest pain, no shortness of breath, and no other cardiac symptoms. &nbsp;We do not know his hydration or electrolyte status. &nbsp;There are quite a few interesting abnormalities on this ECG, and the exact interpretation would, of course, depend upon the patient's clinical status. &nbsp;It would definitely help to be there!</p> <p>First, we note a sinus tachycardia at a rate of 118 bpm. &nbsp;This could be due to very many causes, including but not limited to: &nbsp;dehydration, pain, anxiety, high or low blood glucose, fever, or CHF. &nbsp;The PR and QT intervals are within normal limits. &nbsp;The QRS complexes are narrow. &nbsp;The axis is normal at 0 degrees. &nbsp;The QRS voltage in the lateral leads is on the high side of normal, but we do not know this patient's body type. &nbsp;Voltage as read by the ECG can be influenced by a thin chest (making voltage look larger) or a large chest (making voltage lower).</p> <p>There are T wave abnormalities in the lateral leads: &nbsp;I, aVL, V5 and V6. &nbsp;The T waves are inverted, which can have many meanings. &nbsp;However, when inverted T waves are in the lateral leads, as opposed to the inferior or right chest leads, it is often a sign of ischemia. &nbsp;The flat, horizontal ST segments can also signify coronary artery disease (CAD). &nbsp;This patient denied cardiac symptoms, but his age and history of IDDM make it probably that CAD is a factor. &nbsp;The leads with T wave inversion also have a small amount of ST segment depression. &nbsp;The right precordial leads, V1 and V2, have a small amount of ST elevation, &nbsp;This possibly represents a reciprocal change to the ST depression in V5 and V6.</p> <p>Because we are not at the bedside of this patient, there are many details we do not know. &nbsp;But these inverted T waves could be ischemic T waves, and this requires that the patient be further evaluated.</p> <p>As always, we welcome comments, as this ECG probably has more to say!</p> <p>&nbsp;</p> <p>REFERENCES: &nbsp;<a href="http://ecg-interpretation.blogspot.com/2012/07/ecg-interpretation-review-47-normal.html">Dr. Ken Grauer</a>, &nbsp;<a title="LITFL T waves" href="http://lifeinthefastlane.com/ecg-library/basic/t-wave/">Life In The Fast Lane</a>, <a title="World J Cardiology" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC43225305/#__ffn_sectitle">World Journal of Cardiology</a>&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/91/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 Inverted T waves in Lateral Wall 1/5</option><option value="40">Give Inverted T waves in Lateral Wall 2/5</option><option value="60">Give Inverted T waves in Lateral Wall 3/5</option><option value="80" selected="selected">Give Inverted T waves in Lateral Wall 4/5</option><option value="100">Give Inverted T waves in Lateral Wall 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 >4</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-EfGB5nqS2jGwfBJQwaxg2bOVhxE7wedutC1AUs0NQcY" /> <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/t-wave-inversion" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">T Wave Inversion</a></div><div class="field-item odd"><a href="/ecg/ischemia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ischemia</a></div><div class="field-item even"><a href="/ecg/sinus-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Sinus tachycardia</a></div><div class="field-item odd"><a href="/ecg/pathological-q-waves" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pathological Q waves</a></div><div class="field-item even"><a href="/ecg/bi-atrial-enlargement" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Bi-atrial enlargement</a></div><div class="field-item odd"><a href="/ecg/left-ventricular-hypertrophy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left ventricular hypertrophy</a></div><div class="field-item even"><a href="/ecg/strain-pattern" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Strain pattern</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%2Finverted-t-waves-lateral-wall&amp;title=Inverted%20T%20waves%20in%20Lateral%20Wall"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Wed, 11 Nov 2015 02:45:52 +0000 Dawn 676 at https://www.ecgguru.com https://www.ecgguru.com/ecg/inverted-t-waves-lateral-wall#comments Left Ventricular Hypertrophy https://www.ecgguru.com/ecg/left-ventricular-hypertrophy-0 <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/left-ventricular-hypertrophy-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/LVH100.jpg" width="1800" height="1170" 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" style="margin-bottom: 0.0001pt;"><span style="font-size: 10pt; font-family: Verdana, sans-serif;">This ECG shows voltage criteria for <strong>LVH</strong> (deep S waves V1-V3 and tall R waves V4 - V6). There are many criteria in use for determining LVH, but probably the most commonly used is the <a title="Cardiophile Sokolow Lyon Criteria" href="https://cardiophile.org/sokolow-lyon-criteria-for-left-ventricular-hypertrophy/">Sokolow-Lyon criteria</a>. &nbsp;This criteria says that if the voltage of the S wave in V1 PLUS the tallest R wave of V4, V5, and V6 equals 35 mm or more, the criteria are sufficient for LVH.</span></p> <p class="MsoNormal"><span style="font-size: 10pt; font-family: Verdana, sans-serif;">In order to diagnose LVH from the ECG, we must also show repolarization abnormalities, called the <strong>"strain pattern".</strong> &nbsp;This is seen in sloping ST depressions in all leads with upright QRS complexes. &nbsp;There will also be slight ST elevations (reciprocal to the depressions) in leads with negative QRSs. &nbsp;Chest xray and echocardiogram are important in confirming the extent of the left ventricular enlargement.</span>&nbsp;</p> <p class="MsoNormal"><span style="font-size: 10pt; font-family: Verdana, sans-serif;">The axis of this ECG is not typical of LVH, as it is normal. &nbsp;LVH usually has a left axis deviation. &nbsp; In this ECG, Lead aVL appears to have a pathological Q wave.&nbsp; Possible high lateral damage in the past has skewed the axis downward. The wide p waves in Lead II and the biphasic p waves in V1 may also indicate left atrial strain, a common finding with LVH, called "<strong>P mitrale</strong>".</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/91/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 Left Ventricular Hypertrophy 1/5</option><option value="40">Give Left Ventricular Hypertrophy 2/5</option><option value="60">Give Left Ventricular Hypertrophy 3/5</option><option value="80">Give Left Ventricular Hypertrophy 4/5</option><option value="100" selected="selected">Give Left Ventricular Hypertrophy 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.6</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--4" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-KPhPewvk5QdaEO4SrAtdeewY_eBP9MEizssFF-RwM1M" /> <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/left-ventricular-hypertrophy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left ventricular hypertrophy</a></div><div class="field-item odd"><a href="/ecg/p-mitrale" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">P mitrale</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%2Fleft-ventricular-hypertrophy-0&amp;title=Left%20Ventricular%20Hypertrophy"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Tue, 26 May 2015 20:36:47 +0000 Dawn 641 at https://www.ecgguru.com https://www.ecgguru.com/ecg/left-ventricular-hypertrophy-0#comments ECG Basics: Sinus Rhythm With A Premature Beat https://www.ecgguru.com/ecg/ecg-basics-sinus-rhythm-premature-beat <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-premature-beat"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/139%20Sinus%20rhythm%20w%20first%20deg%20AVB%20Premature%20beat%20and%20LVH%20.jpg" width="1800" height="339" 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 strip offers something interesting for both your basic-level students and for your more advanced students. &nbsp;First, it is a good example of sinus rhythm with a premature beat. &nbsp;The PR interval was measured by the machine at .21 sec (218 ms). &nbsp; &nbsp;The premature beat is supraventricular - that is, it is not a PVC. &nbsp;Because of the slightly long PRI in this strip, it's P wave COULD be buried in the preceding T wave. &nbsp;That would make this a <strong>premature atrial contraction (PAC). &nbsp;</strong></p><p><strong></strong>For discussion with your more advanced students, the P wave could, instead, be <strong>retrograde</strong>, and occurring during the QRS or slightly after it. &nbsp;That would make the premature beat <strong>junctional, </strong>or an<strong> atrial echo beat</strong>. The origin of the premature beat is mostly academic - there is likely no clinical need to determine the origin. &nbsp;</p><p>In looking for clues as to the origin of the premature beat, we would scrutinize the premature beats for "hidden" P waves. &nbsp;Upright and before the premature beat would indicate a PAC. &nbsp;Negative P waves before, during, or after the premature QRS would indicate PJCs. &nbsp;In this strip, the T waves just before the premature beats are slightly deeper than the other T waves. &nbsp;This could indicate atrial "echo", or reciprocal beats, which requires the presence of dual junctional pathways, in which the impulse turns around, reenters the atria, and causes a new beat. &nbsp;It can be helpful to look at multiple leads (the more the better) in your search for P waves. &nbsp;For a look at this patient's 12-lead ECG, go to this <a title="LVH 12-Lead" href="http://www.ecgguru.com/ecg/left-ventricular-hypertrophy-normal-axis">link</a>. &nbsp;</p><p>The P wave of a premature beat often penetrates the SA node and "resets" it, causing the next normal beat to occur after a "normal" R-to-R interval from the premature beat. This fact can help us find "hidden" P waves, as well.</p><p>Another interesting feature of this strip for your students who are interpreting 12-Lead ECGs, is that this ECG shows the criteria for <strong>left ventricular hypertrophy</strong>. &nbsp;See the link above for the 12-lead and discussion.</p><p>&nbsp;</p><p>&nbsp;</p><p>&nbsp;</p><p>&nbsp;</p><p>&nbsp;</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/91/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 ECG Basics: Sinus Rhythm With A Premature Beat 1/5</option><option value="40">Give ECG Basics: Sinus Rhythm With A Premature Beat 2/5</option><option value="60">Give ECG Basics: Sinus Rhythm With A Premature Beat 3/5</option><option value="80" selected="selected">Give ECG Basics: Sinus Rhythm With A Premature Beat 4/5</option><option value="100">Give ECG Basics: Sinus Rhythm With A Premature Beat 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--5" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-73FRoKk5IXk0nQlB0q6kAbjWvh3qAG3JybK_hFEQwwI" /> <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-basics" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ECG Basics</a></div><div class="field-item odd"><a href="/ecg/premature-junctional-contraction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Premature junctional contraction</a></div><div class="field-item even"><a href="/ecg/premature-atrial-contraction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Premature atrial contraction</a></div><div class="field-item odd"><a href="/ecg/left-ventricular-hypertrophy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left ventricular hypertrophy</a></div><div class="field-item even"><a href="/ecg/atrial-echo-beat" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial echo beat</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></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%2Fecg-basics-sinus-rhythm-premature-beat&amp;title=ECG%20Basics%3A%20%20Sinus%20Rhythm%20With%20A%20Premature%20Beat%20"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Thu, 19 Mar 2015 20:11:57 +0000 Dawn 629 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-sinus-rhythm-premature-beat#comments Left Bundle Branch Block https://www.ecgguru.com/ecg/left-bundle-branch-block-2 <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/left-bundle-branch-block-2"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/LB115.jpg" width="2057" height="1566" alt="" /></a></div><div class="field-item odd"><a href="/ecg/left-bundle-branch-block-2"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/LB115%20P%20waves%20marked.jpg" width="200" height="352" alt="" /></a></div><div class="field-item even"><a href="/ecg/left-bundle-branch-block-2"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/LB115%20close%20up%20of%20QRS%20width%20marks.jpg" width="200" height="313" 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 good example of sinus rhythm with left bundle branch block. &nbsp;There is some irregularity due to a PAC at the beginning. &nbsp;The QRS is wide at 144 ms (.14 seconds). &nbsp;There is also first-degree AV block, with a prolonged PR interval of 228 ms. &nbsp;The criteria for diagnosis of left BBB are: &nbsp;wide QRS, supraventricular rhythm, and a negatively-deflected QRS in V1 with a positive QRS in Leads I and V6. &nbsp;</p><p>Left bundle branch block can be associated with many forms of heart disease, including CHF. &nbsp;It can be permanent, transient, intermittent, or rate-related. &nbsp;The wide QRS of LBBB significantly decreases cardiac output, causing poor perfusion symptoms in some people.</p><p>This ECG is a good one for your students who are just transitioning from reading rhythm strips to reading 12-lead ECGs. &nbsp;It shows the value of multi-lead assessment of rhythms. You will notice that P waves are difficult to see in some leads. &nbsp;Armed with the knowledge that the four channels on this ECG are run simultaneously, you can show the students how finding P waves in one lead will allow you to find them in the leads that are above and below that lead.&nbsp;</p><p>Similarly, it can be difficult to see the QRS width in some leads. &nbsp;The leads in the same vertical column can help you see the QRS's true width, even if part of the QRS is "flat" in the isoelectric baseline.</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/91/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 Left Bundle Branch Block 1/5</option><option value="40">Give Left Bundle Branch Block 2/5</option><option value="60">Give Left Bundle Branch Block 3/5</option><option value="80">Give Left Bundle Branch Block 4/5</option><option value="100" selected="selected">Give Left Bundle Branch Block 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-YOHOD0BKEyYtqPvPg2L_-tN_q-3MZ-GmaSXULgRbbCA" /> <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/left-bundle-branch-block-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left bundle branch block</a></div><div class="field-item odd"><a href="/ecg/lbbb" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">LBBB</a></div><div class="field-item even"><a href="/ecg/bundle-branch-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Bundle branch block</a></div><div class="field-item odd"><a href="/ecg/multi-lead-assessment" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Multi-lead assessment</a></div><div class="field-item even"><a href="/ecg/left-ventricular-hypertrophy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left ventricular hypertrophy</a></div><div class="field-item odd"><a href="/ecg/pac" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">PAC</a></div><div class="field-item even"><a href="/ecg/premature-atrial-contraction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Premature atrial 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_6"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fleft-bundle-branch-block-2&amp;title=Left%20Bundle%20Branch%20Block"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Fri, 08 Aug 2014 03:57:36 +0000 Dawn 592 at https://www.ecgguru.com https://www.ecgguru.com/ecg/left-bundle-branch-block-2#comments Left Ventricular Hypertrophy With Strain https://www.ecgguru.com/ecg/left-ventricular-hypertrophy-strain-0 <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/left-ventricular-hypertrophy-strain-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/LVH%20105_0.jpg" width="1800" height="891" 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 is from a man with left ventricular hypertrophy. &nbsp;LVH causes taller-than-normal QRS complexes in leads oriented toward the left side of the heart, such as Leads I, II, aVL, V4, V5, and V6. &nbsp;Leads on the opposite side, such as V1, V2, and V3, will have deeper-than-normal S waves. &nbsp;A commonly-used criteria for determination of LVH is the&nbsp;<span style="font-family: sans-serif; font-size: 13px; line-height: 19.1875px;">&nbsp;</span><strong style="font-family: sans-serif; font-size: 13px; line-height: 19.1875px;">Sokolow-Lyon index: &nbsp; &nbsp;</strong><strong style="font-family: sans-serif; line-height: 10.838068008422852px;"><span style="font-size: xx-small;">&nbsp;</span></strong><span style="font-family: sans-serif; font-size: 13px; line-height: 19.1875px;">S in V</span><sub style="font-family: sans-serif; line-height: 1em;">1</sub><span style="font-family: sans-serif; font-size: 13px; line-height: 19.1875px;">&nbsp;</span><span style="font-family: sans-serif; font-size: 13px; line-height: 19.1875px;">+ R in V</span><sub style="font-family: sans-serif; line-height: 1em;">5</sub><span style="font-family: sans-serif; font-size: 13px; line-height: 19.1875px;">&nbsp;</span><span style="font-family: sans-serif; font-size: 13px; line-height: 19.1875px;">or V</span><sub style="font-family: sans-serif; line-height: 1em;">6</sub><span style="font-family: sans-serif; font-size: 13px; line-height: 19.1875px;">&nbsp;</span><span style="font-family: sans-serif; font-size: 13px; line-height: 19.1875px;">(whichever is larger) ≥ 35&nbsp;mm (≥ 7 large squares); &nbsp;and &nbsp;</span><span style="font-family: sans-serif; font-size: 13px; line-height: 19.1875px;">R in aVL ≥ 11&nbsp;mm. &nbsp;There is no perfect ECG criteria for determining LVH. The most accurate way to evaluate the size and thickness of the chambers of the heart is echocardiogram (ultrasound). &nbsp;Frequently, there is left axis deviation, especially if the hypertrophy is confined to the left ventricle.</span></p><p><span style="font-family: sans-serif; font-size: 13px; line-height: 19.1875px;">The left ventricle can be enlarged for many reasons, some worse than others. &nbsp;Athletes naturally enlarge the heart, as they work the muscle. &nbsp;Pathological causes for LVH can include anything that strains the heart as it pushes against increased afterload, such as hypertension and aortic stenosis, and diseases of the myocardium, such as cardiac myopathies.</span></p><p><span style="font-family: sans-serif; font-size: 13px; line-height: 19.1875px;">ECGs that show LVH often have signs of other problems, including enlargement of the atria and/or the right ventricle. &nbsp;LVH does not preclude the diagnosis of acute coronary insufficiency or myocardial infarction, but it can make the signs of other problems more difficult to see. &nbsp;When LVH is caused by a pathological condition, we often see the "strain" pattern, which is ST depression and T wave inversion in leads with upright QRS complexes (the lateral leads). &nbsp;A reciprocal ST elevation can occur in the right-sided leads, which can be confusing to those looking for STEMI.</span></p><p><span style="font-family: sans-serif; font-size: 13px; line-height: 19.1875px;">&nbsp;Dr. Ed Burns, of <a title="Life in the Fast Lane" href="http://lifeinthefastlane.com/ecg-library/basics/left-ventricular-hypertrophy/">Life In the Fast Lane</a>, has a very good page describing the criteria and facts of LVH. &nbsp; &nbsp; Dr. Ken Grauer discusses LVH&nbsp;</span><a style="line-height: 1.538em;" title="Dr. Grauer LVH" href="http://ecg-interpretation.blogspot.com/2013/08/ecg-interpretation-review-73-lvh.html">Here</a>, and in all of his publications and on his website.</p><p>If you look closely at this ECG, you will find other abnormalities, and clinical corelation is always warranted.</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/91/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 Left Ventricular Hypertrophy With Strain 1/5</option><option value="40">Give Left Ventricular Hypertrophy With Strain 2/5</option><option value="60">Give Left Ventricular Hypertrophy With Strain 3/5</option><option value="80" selected="selected">Give Left Ventricular Hypertrophy With Strain 4/5</option><option value="100">Give Left Ventricular Hypertrophy With Strain 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 >3</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-4Id7GBgkGJX0xT4wEmQII_uGelGNBV8C0gUBKatTw9M" /> <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/left-ventricular-hypertrophy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left ventricular hypertrophy</a></div><div class="field-item odd"><a href="/ecg/strain-pattern" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Strain pattern</a></div><div class="field-item even"><a href="/ecg/first-degree-av-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">First-degree AV block</a></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%2Fecg%2Fleft-ventricular-hypertrophy-strain-0&amp;title=Left%20Ventricular%20Hypertrophy%20With%20Strain"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Thu, 12 Dec 2013 16:38:35 +0000 Dawn 524 at https://www.ecgguru.com https://www.ecgguru.com/ecg/left-ventricular-hypertrophy-strain-0#comments Acute M.I. In A Patient With Left Ventricular Hypertrophy https://www.ecgguru.com/ecg/acute-mi-patient-left-ventricular-hypertrophy <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/acute-mi-patient-left-ventricular-hypertrophy"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/LMILVH100.png" width="1800" height="1347" 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><span style="font-family: Verdana, Helvetica, Arial, sans-serif; line-height: 21.111112594604492px;">This 60-year-old man presented to the Emergency Department with chest pain and shortness of breath. &nbsp;He gave a history of having seven coronary artery stents in the past. </span></p><p><span style="font-family: Verdana, Helvetica, Arial, sans-serif; line-height: 21.111112594604492px;">This is a good ECG for demonstrating the voltage and ST criteria for LVH and acute anterio-lateral wall M.I. in the same patient, where both conditions have been confirmed by other tests.&nbsp;&nbsp; If you are teaching the topics of ST elevation M.I., or left ventricular hypertrophy, you will probably have to address the issue that LVH can be considered a "mimic" for STEMI, especially for beginners.&nbsp; This is because </span><strong style="font-family: Verdana, Helvetica, Arial, sans-serif; line-height: 21.10416603088379px;">LVH causes ST depression in leads with</strong><span style="font-family: Verdana, Helvetica, Arial, sans-serif; line-height: 21.10416603088379px;">&nbsp;<strong>upr</strong></span><span style="font-family: Verdana, Helvetica, Arial, sans-serif; line-height: 21.111112594604492px;"><strong>ight QRS complexes</strong>, and reciprocal <strong>ST elevation in leads with negative QRS complexes.&nbsp;</strong> This is called ST segment discordance.&nbsp; The ST changes in LVH are due to the "strain" pattern, indicating strain on the left ventricular myocardium.&nbsp; It is true that some ST elevation will appear in V1 and V2 in these patients, and can be mistaken for M.I.&nbsp; In the ECG shown here, the patient has definite ST elevation in leads which would NORMALLY have depression in the LVH strain pattern.&nbsp; Leads V3 through V6 and I and aVL have ST elevation that is not discordant, and is definitely real. In addition, the ST elevation in V1 and V2 are greater than expected for LVH alone.</span></p><p><span style="font-family: Verdana, Helvetica, Arial, sans-serif; line-height: 21.111112594604492px;">The criteria most often used to determine LVH is the<span style="text-decoration: underline;"> Sokolov-Lyon Criteria</span>, (S wave in V1 + R wave in V5 or V6 = 35 mm). &nbsp;It is best to confirm the LVH with echocardiograhy.</span></p><p><span style="font-family: Verdana, Helvetica, Arial, sans-serif; line-height: 21.111112594604492px;">This patient was taken to the cath lab, and the M.I. was confirmed, although his case was lost to followup, and we do not know if he received more angioplasty, coronary artery bypass, or other treatment, or what his condition was post catheterization.</span></p><p><span style="font-family: Verdana, Helvetica, Arial, sans-serif; line-height: 21.111112594604492px;">For a similar ECG and discussion on this site, go to this<a title="LVH with AWMI" href="http://www.ecgguru.com/ecg/left-ventricular-hypertrophy-anterior-wall-mi"> LINK</a>.</span></p><p><span style="font-family: Verdana, Helvetica, Arial, sans-serif; line-height: 21.111112594604492px;">As always, the information presented with the Instructors' Collection series is very basic, and we welcome and look forward to comments from the ECG GURUs out there!</span></p><p><span style="font-family: Verdana, Helvetica, Arial, sans-serif; line-height: 21.111112594604492px;"><br /></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/91/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 Acute M.I. In A Patient With Left Ventricular Hypertrophy 1/5</option><option value="40">Give Acute M.I. In A Patient With Left Ventricular Hypertrophy 2/5</option><option value="60">Give Acute M.I. In A Patient With Left Ventricular Hypertrophy 3/5</option><option value="80" selected="selected">Give Acute M.I. In A Patient With Left Ventricular Hypertrophy 4/5</option><option value="100">Give Acute M.I. In A Patient With Left Ventricular Hypertrophy 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 >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-bzOThmMR06bGVbWIU9GZKG0vkUucCVK2bbpshPhcxLA" /> <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/left-ventricular-hypertrophy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left ventricular hypertrophy</a></div><div class="field-item odd"><a href="/ecg/stemi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">STEMI</a></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%2Fecg%2Facute-mi-patient-left-ventricular-hypertrophy&amp;title=Acute%20M.I.%20In%20A%20Patient%20With%20Left%20Ventricular%20Hypertrophy"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 07 Jul 2013 20:38:15 +0000 Dawn 461 at https://www.ecgguru.com https://www.ecgguru.com/ecg/acute-mi-patient-left-ventricular-hypertrophy#comments Jason's Blog: ECG Challenge of the Week for March 3rd - 10th. https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-march-3rd-10th <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-3rd-10th"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%202h%20ladder.png" width="765" height="502" 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> <br>73-year-old white man. <br><br><br></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/91/feed" method="post" id="fivestar-custom-widget--9" 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--18" 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 3rd - 10th. 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for March 3rd - 10th. 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for March 3rd - 10th. 3/5</option><option value="80" selected="selected">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for March 3rd - 10th. 4/5</option><option value="100">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for March 3rd - 10th. 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 >9</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--9" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-Q7SGDIr_Zxvfz6aGzcr29QFU1mEi6JznHE7-8Azqpbc" /> <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_9"> <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-3rd-10th&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20of%20the%20Week%20for%20March%203rd%20-%2010th."><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sat, 02 Mar 2013 15:51:33 +0000 jer5150 409 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-march-3rd-10th#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/91/feed" method="post" id="fivestar-custom-widget--10" 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--20" 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--10" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-XLfc_jcGu9pvtw90bLIT2Ql3a3DSFm2zLSc-TGzGB-0" /> <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_10"> <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