Hi, everyone! Happy Winter holidays. We are so happy you are here. We have one BIG REQUEST that would make the ECG Guru team so happy. We would love to hear your comments and field your questions! There is a "Comments" section below each piece of content.
The Patient This ECG was obtained from a 76-year-old woman who had just lost responsiveness while under care of an EMS crew. This tracing was obtained before a trans-cutaneous pacemaker was applied.
The ECG The most noticeable feature of this ECG is the extremely slow rate. In fact, there are only two QRS complexes visible. The P waves are regular at a rate of about 145 bpm, so the underlying rhythm is sinus tachycardia. NONE of the P waves are conducted, as evidenced by the different “PR intervals” in the two QRS complexes seen. This is complete heart block at it’s most extreme – the QRS complexes represent a very insufficient escape rhythm. A pacemaker is the only immediate treatment for this rhythm. Unfortunately, we don’t know the outcome for this patient.
It is very difficult to make judgements about the QRS complexes with only two of them, visible in three leads each. The first set show the criteria for left ventricular hypertrophy. The QRS in aVL is 20 mm tall, and anything over 11 mm meets voltage criteria for LVH. In addition, the ST segments have the “strain” pattern, another sign of LVH. The second QRS complexes are not typical of a normal ECG or one with LVH. We cannot vouch for the precordial lead placement.
There is some disagreement in the literature regarding the naming of the blocks. Some consider “high-grade” to be only second-degree AVB with two or more consecutive non-conducted P waves. Others include third-degree AVB in the “high-grade” category. It can come down to just semantics – the RATE and how the patient responds to the rate is the primary consideration. Classification as to the origin of the block is helpful when determining the best long-term treatment decisions.
This is a good ECG for teaching the concept of AV dissociation, and how dangerous third-degree AV blocks and high-grade second-degree AV blocks can be.
Are you looking for a comprehensive ECG glossary that goes beyond simply defining words? Dr. Ken Grauer, who is the ECG Guru's Consulting Expert, has a Glossary available on his website that explains the terms. Instructors and students alike will benefit from having this glossary readily available. The glossary is exerpted from his e-Publication, "A 1st Book On ECGs - 2014", available on Amazon.
ECG Guru Ads - Products and Services of Interest to our Members
If you would like to place ads for products or services of interest to our readers, please contact us at [email protected]
1924: Willem Einthoven wins the Nobel prize for inventing the electrocardiograph.
All our content is FREE & COPYRIGHT FREE for non-commercial use
Please be courteous and leave any watermark or author attribution on content you reproduce.
Recent blog posts
- The ECG Guru's Big Wish For 2020
- Instructors' Collection ECG: Wide QRS Complex With First-degree AV Block
- Do You Teach ECG or Cardiology Classes?
- Want Some Tips On Teaching Axis Determination?
- Basics of ECG Rhythm Diagnosis Videos From Dr. Ken Grauer, M.D.
- Are You New to Laddergrams?
- ECG TEACHING VIDEOS - An Important Tool For Teachers and Students Alike
- ECG Challenge donated by Guru member "chireu".
- Jason's Blog: ECG Challenge for the months of July and August, 2014.
- Jason's Blog: ECG Challenge for the month of June, 2014.
- Jason's Blog: ECG Challenge for the month of May, 2014.
- Glossary of ECG Terms by Dr. Ken Grauer
- Jason's Blog: ECG Challenge for the month of April, 2014.
- Book Review: Dr. Ken Grauer's ECG Pocket Brain 2014, Expanded Version E-PUB
- Amal Mattu's ECG Case of the Week: Feb 17, 2014