We originally published this ECG in 2012. It was generously donated to the ECG Guru website by our friend and ECG Guru Extraordinaire, Jason Roediger. We are re-publishing it today, as it is a great ECG for illustrating how helpful laddergrams can be for showing conduction in dysrhythmias.
A laddergram is a diagram of conduction through the heart, presented in a minimum of three tiers, one for the atria, one for the AV junction, and one for the ventricles. Laddergrams are very useful for presenting and testing your theory of a dysrhythmia. Instructors often use them to illustrate complex dysrhythmia mechanisms.
This is an ECG I performed a couple of years ago on an asymptomatic 83-year old man as an outpatient procedure.
The computer interpreted this as: "Marked sinus bradycardia [with] Frequent Premature ventricular complexes". IS THE COMPUTER CORRECT? Is there more than one plausible interpretation? What is the differential diagnosis?
Patient data: 54-year old man who recently underwent a major cardiac procedure. At first glance, this ECG may not appear to be particularly unique but a closer inspection reveals something unusual going on here.
Patient data: 64-year old man who, prior to this ECG, had been in normal sinus rhythm. Whatever your level of sophistication in rhythm interpretation (i.e., basic, intermediate, or advanced), this ECG has a little bit of something for everybody. Basic interpreters will undoubtedly recognize the dominant disturbance of rhythm. Intermediate interpreters will probably add more descriptors to their interpretation that will better describe the overall pattern. Advanced interpreters will recognize the
The only patient data I have is that this ECG is from a 73-year old man. At the request of the site administrator (Dawn Altman), I'm posting this ECG because there isn't one quite like it in the Guru's archives. Some readers will recognize it as one I recently posted on another website. This one lives up to the title of "Challenging". I'll make the same general statement I did on the other website: You'll need to make careful measurements with calipers on this ECG to come to the correct interpretation.
Sticking with the same general theme from my last ECG Challenge for the months of September and October, 2013. This is more of a back-to-basics for some readers but will still challenge others. No information for this patient other than it was an adult. How would you interpret this?
Patient's clinical data: 56-year old man.
At Dawn's request, this month's ECG is laying down the foundation for a topic she wanted me to eventually talk about on the ECG Guru. On this ECG, I'm not just looking for the obvious disturbance of rhythm. This type of ECG is literally begging for a laddergram to help reveal the mechanism responsible for a couple of very subtle and rare findings.
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