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Impending Trifascicular AV Block

Submitted by Dr A Röschl on Mon, 08/28/2023 - 06:24

Here we see the EKG of a 63-year-old man with CAD without relevant coronary stenosis. He complains of slightly reduced performance, but no other symptoms. The ECG shows the following changes:

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WHY IS THIS VT

Submitted by Dr A Röschl on Sat, 08/12/2023 - 02:21

The tachycardia starts with a premature broad QRS complex. We see nonconducted sinus P waves. There are more QRS complexes than P waves, so it is AV-dissociation. There is no doubt that there is a VT present here.

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SINUS ARRHYTHMIA

Submitted by Dr A Röschl on Thu, 08/10/2023 - 01:07

Here we see the EKG of a 15-year-old girl. The rhythm is irregular, with the heart rate fluctuating between approximately 60 and 90 beats per minute. All P waves are identical, and the PR interval is always constant. Therefore, a sinus arrhythmia is present. In this case, it is a respiratory sinus arrhythmia, which is commonly found in younger individuals. The heart rate increases reflexively during inspiration and decreases during exspiration. This physiological sinus arrhythmia is usually no longer present in older individuals.

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SECOND DEGREE AVB TYPE I (WENCKEBACH)

Submitted by Dr A Röschl on Sat, 08/05/2023 - 03:27

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).

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SSS (SICK SINUS SYNDROME)

Submitted by Dr A Röschl on Thu, 08/03/2023 - 01:37

Why does this EKG indicate a sick sinus node? First, we observe a sinus rhythm with a rate just below 60 bpm. Then, there is a pause of approximately 3000 ms, followed not by a sinus beat, but by a junctional escape beat (retrograde/inverted P-wave immediately after the QRS complex). This ECG was recorded at the general practitioner's office, and it can be assumed that no vagal stimulus contributed to the arrhythmia.

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PACEMAKER ECG: PSEUDOFUSION - FUSION

Submitted by Dr A Röschl on Thu, 08/03/2023 - 01:11

Here is a Pacemaker ECG with no signs of PM malfunction: Beat A is an intrinsic beat (atrial fibrillation). Beat B is a pseudofusion beat. Beat C is a fully paced beat. Beat D is a fusion beat. Ventricular fusion is the electrical summation of an intrinsic beat of the heart and depolarization from a pacing stimulus. The morphology lies between a fully paced beat and a complete intrinsic beat.

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Second-degree AV Block, Mobitz Type II

Submitted by Dr A Röschl on Wed, 08/02/2023 - 02:35

We are observing EKG strip 1 in a Holter EKG recording; what can be said about it? There is a sinus rhythm with a normal PQ interval. After 3 sinus beats, a 2:1 AV block develops. When 2:1 AV block occurs, we should not refer to this as Wenckebach (Mobitz I) or Mobitz II, but rather as a high-grade AV block (other forms include: 3:1, 4:1, 5:1, etc.). The 2:1 block can be intranodally localized and behave benignly like a Wenckebach block typically does. However, it could also be infranodally localized with a potentially serious prognosis.

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BRUGADA PATTERN

Submitted by Dr A Röschl on Wed, 08/02/2023 - 02:01

This patient is a 50-year-old man. His brother was diagnosed with epilepsy and died during a seizure at the age of 21.

Parts of the following text I have taken over from Dawn`s explanation on Brugada pattern/Brugada syndrome:

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Ventricular Tachycardia In A Patient With CAD And An Old Inferior M.I.

Submitted by Dr A Röschl on Tue, 08/01/2023 - 00:24

Broad complex tachycardia in a 78-year-old patient with coronary heart disease (CHD) and an old inferior myocardial infarction. Why is this a ventricular tachycardia (VT) and not a supraventricular tachycardia (SVT) with aberrant conduction? Broad complex tachycardia is generally about 80% likely to be ventricular in origin. However, in a patient with CHD and a history of myocardial infarction, this likelihood increases to about 90%. What other clues are there? The tachycardia initiates with a premature QRS complex without a preceding/premature P-wave.

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ECG OF A 3 YO BOY, IS IT NORMAL?

Submitted by Dr A Röschl on Mon, 07/31/2023 - 04:17

Here is the ECG of a 3-year-old boy. Is there cause for concern? The ECG shows a sinus rhythm with significant sinus arrhythmia. The heart rate increases with inspiration and decreases with expiration, which is called respiratory sinus arrhythmia. The QRS-axis is between 60 and 90 degrees, which is physiological at this age. The negative T-waves in V1-V3 (V4) are also age-appropriately normal. Therefore, there is no reason for concern; the ECG is considered normal for the child's age.

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