ECG Guru - Instructor Resources - A Fib https://www.ecgguru.com/ecg/fib en Atrial Fibrillation With Rate-related Left Bundle Branch Block https://www.ecgguru.com/blog/atrial-fibrillation-rate-related-left-bundle-branch-block <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/atrial-fibrillation-rate-related-left-bundle-branch-block"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AFIB%20rate%20related.jpg" width="2428" height="1576" 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>For a better overview, the leads aVL and V2-V4 are not shown in this ECG. The basic rhythm is atrial fibrillation (no P waves or flutter waves visible, but fibrillation waves). When the conduction rate drops, the QRS complexes are narrow. Faster conduction results in wide QRS complexes with LBBB morphology. This is an example of phase 3 (acceleration dependant) LBBB.</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/19/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 Atrial Fibrillation With Rate-related Left Bundle Branch Block 1/5</option><option value="40">Give Atrial Fibrillation With Rate-related Left Bundle Branch Block 2/5</option><option value="60" selected="selected">Give Atrial Fibrillation With Rate-related Left Bundle Branch Block 3/5</option><option value="80">Give Atrial Fibrillation With Rate-related Left Bundle Branch Block 4/5</option><option value="100">Give Atrial Fibrillation With Rate-related 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 >3</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" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-DkfEtdpvbn810CO84g7R7s_OzHmaybOE07QLeBRvswg" /> <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%2Fatrial-fibrillation-rate-related-left-bundle-branch-block&amp;title=Atrial%20Fibrillation%20With%20Rate-related%20Left%20Bundle%20Branch%20Block"><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> Tue, 16 Jan 2024 09:20:31 +0000 Dr A Röschl 894 at https://www.ecgguru.com https://www.ecgguru.com/blog/atrial-fibrillation-rate-related-left-bundle-branch-block#comments Atrial fibrillation and Type 2 M.I. https://www.ecgguru.com/ecg/atrial-fibrillation-and-type-2-mi <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-fibrillation-and-type-2-mi"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/12%20channel%20page%20one.jpg" width="1800" height="1151" alt="" /></a></div><div class="field-item odd"><a href="/ecg/atrial-fibrillation-and-type-2-mi"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/12%20channel%20page%202.jpg" width="1800" height="1116" 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 style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt; line-height: 107%; color: #00b050;">The Patient:</span></strong><span style="color: #00b050;"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span></span>This excellent teaching case was donated to the ECG Guru by our friend, Sebastian Garay (who is an ECG Guru himself).<span style="mso-spacerun: yes;">&nbsp; </span>It was taken from a 33-year-old man who was complaining of chest pain and palpitations. He reported a similar episode about six months prior, but failed to follow up with cardiology. Was told by his medical care provider that he had atrial fib.</p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt; line-height: 107%; color: #00b050;">The ECG:</span></strong><span style="color: #00b050;"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span>We are able in this case to provide a 12-lead ECG with each lead recorded for the entire width of the paper. This has the advantage of producing twelve ten-second rhythm strips.<span style="mso-spacerun: yes;">&nbsp; </span>Page one contains the limb leads, and page two shows us the precordial leads.</p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;">The rhythm</strong> is atrial fibrillation, with a heart <strong style="mso-bidi-font-weight: normal;">rate</strong> of 133 bpm and an irregularly irregular rhythm. The <strong style="mso-bidi-font-weight: normal;">QRS axis</strong> is extreme left at about -75 degrees.<span style="mso-spacerun: yes;">&nbsp; </span>This has caused Leads II, III, and aVF to be negatively deflected, and aVR and aVL to be positive. Lead I is biphasic, low voltage, and mostly positive, indicating that the axis travels almost perpendicular to Lead I, but slightly toward it.</p><p class="MsoNormal">The machine mistakenly gives us a reading for PR interval and P wave axis, even though there are no P waves.<span style="mso-spacerun: yes;">&nbsp; </span>The QRS is on the wide side without being abnormal at .10 seconds (100 ms). The QTc is within normal limits, although it might be considered “borderline”, with 431-450 usually considered borderline.</p><p class="MsoNormal">There appears to be very <strong style="mso-bidi-font-weight: normal;">slight ST elevation</strong> in the inferior leads with no coving of the ST segment.<span style="mso-spacerun: yes;">&nbsp; </span>We see the same ST appearance in Leads V3 through V6.<span style="mso-spacerun: yes;">&nbsp; </span>The <strong style="mso-bidi-font-weight: normal;">axis in the vertical plane</strong>, as indicated by the chest, or precordial, leads, is also unusual.<span style="mso-spacerun: yes;">&nbsp; </span>It appeared the same in multiple ECGs run by different people, so lead placement is presumed to be correct.<span style="mso-spacerun: yes;">&nbsp; </span>V1 and V2 are more upright than negative, which is not normal. The most common cause of upright QRS in V1 is right bundle branch block, which is not present here. Another common cause of a dominant R wave in V1 and V2 is <strong style="mso-bidi-font-weight: normal;">right ventricular enlargement.</strong><span style="mso-spacerun: yes;">&nbsp; </span>V3, V4, V5, and V6 all look very much alike, with no R wave progression, also a sign of right ventricular enlargement.<span style="mso-spacerun: yes;">&nbsp; </span>First glance appears to show pathological Q waves in many leads, but on closer inspection, there are small “r” waves.<span style="mso-spacerun: yes;">&nbsp; </span>Other signs of right ventricular enlargement, such as the “strain pattern” (ST depression and T wave inversion in right-sided leads), are not evident here.</p><p class="MsoNormal">So, to recap, this young and symptomatic man has had intermittent bouts of atrial fibrillation and chest pain.<span style="mso-spacerun: yes;">&nbsp; </span>We do not know of other symptoms, but the ECG is abnormal in many ways, especially for a young person. His symptoms also point to serious heart disease.</p><p class="MsoNormal">The Hospital Course:<span style="mso-spacerun: yes;">&nbsp; </span><span style="mso-spacerun: yes;">&nbsp;</span><span style="mso-spacerun: yes;">&nbsp;</span>The patient presented to the Emergency Department in atrial fib with a rapid ventricular response at 140/min.<span style="mso-spacerun: yes;">&nbsp; </span>His troponin levels were all critically high at 1.230, 1.30, 1.230, and 1.250. (Normal 0.00 – 0.40). Later that day, he converted to sinus rhythm with PACs. The next day, cardiac catheterization was performed.</p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt; line-height: 107%; color: #00b050;">Cath Findings:</span></strong><span style="color: #00b050;"><span style="mso-spacerun: yes;">&nbsp;&nbsp; </span></span>Marked right heart pressure variations with respirations. Mild, non-obstructive coronary artery disease in a co-dominant system. Severe non-ischemic cardiomyopathy (NICM). The left ventriculogram showed global hypokinesis, with an ejection fraction of 20-25% (normal EF is 60% or greater).<span style="mso-spacerun: yes;">&nbsp; </span></p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt; line-height: 107%; color: #00b050;">Diagnosis:<span style="mso-spacerun: yes;">&nbsp; </span></span></strong>Unspecified atrial fib and <strong style="mso-bidi-font-weight: normal;">Type 2 M.I.<span style="mso-spacerun: yes;">&nbsp; </span></strong>This is a term now being used for M.I. due to an underlying cause other than coronary artery plaque rupture and thrombosis.<span style="mso-spacerun: yes;">&nbsp; </span>In this case, loss of cardiac output due to atrial fib with RVR and NICM caused a defect in the supply-demand conditions in his heart.<span style="mso-spacerun: yes;">&nbsp; </span>Even with open coronary arteries, his heart could not keep up enough cardiac output to adequately supply the coronary arteries and the myocardium. The rapid rate increased the demand side of the equation, while not enhancing the supply side.</p><p class="MsoNormal">Patient Outcome:<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span>The patient was discharged home with instructions to follow up with his primary care provider and cardiologist.<span style="mso-spacerun: yes;">&nbsp; </span>Even in the absence of heart failure symptoms, he was started on medications for failure, as well as medications for the atrial fibrillation.</p><p class="MsoNormal">&nbsp;</p><p class="MsoNormal">Our thanks to Sebastian Garay for sharing this great <strong style="mso-bidi-font-weight: normal;">non-STEMI</strong> example.<strong style="mso-bidi-font-weight: normal;"></strong></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/19/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 Atrial fibrillation and Type 2 M.I. 1/5</option><option value="40">Give Atrial fibrillation and Type 2 M.I. 2/5</option><option value="60">Give Atrial fibrillation and Type 2 M.I. 3/5</option><option value="80" selected="selected">Give Atrial fibrillation and Type 2 M.I. 4/5</option><option value="100">Give Atrial fibrillation and Type 2 M.I. 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 >9</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-OkQV-zf3mWux0ZZVute7qMqXTOpFuhfhBTYwDAc3UJY" /> <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-fibrillation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial fibrillation</a></div><div class="field-item odd"><a href="/ecg/fib" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">A Fib</a></div><div class="field-item even"><a href="/ecg/type-2-mi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Type 2 M.I.</a></div><div class="field-item odd"><a href="/ecg/mi-non-obstructive-coronary-arteries" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">M.I. with non-obstructive coronary arteries</a></div><div class="field-item even"><a href="/ecg/nstemi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">NSTEMI</a></div><div class="field-item odd"><a href="/ecg/non-stemi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Non-STEMI</a></div><div class="field-item even"><a href="/ecg/right-ventricular-enlargement" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Right ventricular enlargement</a></div><div class="field-item odd"><a href="/ecg/12-channel-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">12 channel ECG</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%2Fatrial-fibrillation-and-type-2-mi&amp;title=Atrial%20fibrillation%20and%20Type%202%20M.I."><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sat, 20 Jul 2019 19:41:02 +0000 Dawn 774 at https://www.ecgguru.com https://www.ecgguru.com/ecg/atrial-fibrillation-and-type-2-mi#comments Inferior Wall M.I. With Atrial Fibrillation https://www.ecgguru.com/ecg/inferior-wall-mi-atrial-fibrillation <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/inferior-wall-mi-atrial-fibrillation"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/IWMI121%20Ken%20Grauer%20markup.jpg" width="1878" height="946" alt="" /></a></div><div class="field-item odd"><a href="/ecg/inferior-wall-mi-atrial-fibrillation"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/IW121%20Post%20%20AFL%20%20Old%20AWMI_0.jpg" width="2006" height="1021" 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: .0001pt; line-height: normal;"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt; color: #548235; mso-themecolor: accent6; mso-themeshade: 191; mso-style-textfill-fill-color: #548235; mso-style-textfill-fill-themecolor: accent6; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">The Patient</span></strong><span style="font-size: 14.0pt; color: #548235; mso-themecolor: accent6; mso-themeshade: 191; mso-style-textfill-fill-color: #548235; mso-style-textfill-fill-themecolor: accent6; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;"><span style="mso-spacerun: yes;">&nbsp;&nbsp; </span></span><span style="font-size: 12.0pt;">This ECG was obtained from a 74-year-old man who had a history of COPD. He was complaining of severe chest pain at the time of the ECG.</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt; color: #548235; mso-themecolor: accent6; mso-themeshade: 191; mso-style-textfill-fill-color: #548235; mso-style-textfill-fill-themecolor: accent6; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">The ECG</span></strong><span style="font-size: 14.0pt; color: #548235; mso-themecolor: accent6; mso-themeshade: 191; mso-style-textfill-fill-color: #548235; mso-style-textfill-fill-themecolor: accent6; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span></span><span style="font-size: 12.0pt;">The <span style="color: #548235; mso-themecolor: accent6; mso-themeshade: 191; mso-style-textfill-fill-color: #548235; mso-style-textfill-fill-themecolor: accent6; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">rhythm</span> is atrial fib or flutter (the R to R intervals are irregular, but seem to repeat about 4 interals).<span style="mso-spacerun: yes;">&nbsp; </span>Flutter waves are seen during some of the longer intervals. The rate is approximately 90 beats per minute.<span style="mso-spacerun: yes;">&nbsp; </span>The <span style="color: #548235; mso-themecolor: accent6; mso-themeshade: 191; mso-style-textfill-fill-color: #548235; mso-style-textfill-fill-themecolor: accent6; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">ST segments </span>are very noticeably elevated in Leads II, III, and aVF.<span style="mso-spacerun: yes;">&nbsp; </span>There is reciprocal ST depression in Leads I and aVL, and also in all the precordial leads.<span style="mso-spacerun: yes;">&nbsp; </span></span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 12.0pt;">There is poor <span style="color: #548235; mso-themecolor: accent6; mso-themeshade: 191; mso-style-textfill-fill-color: #548235; mso-style-textfill-fill-themecolor: accent6; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">R wave progression</span>, with the transition from negative to positive in V<sub>5</sub>. The <span style="color: #548235; mso-themecolor: accent6; mso-themeshade: 191; mso-style-textfill-fill-color: #548235; mso-style-textfill-fill-themecolor: accent6; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">QRS width </span>is difficult to determine with so much ST elevation and depression.<span style="mso-spacerun: yes;">&nbsp; </span>Lead I and Leads V<sub>4</sub> through V<sub>6</sub> have fairly clear onset and offset (J point), and appear to be about .09-.10 seconds. There are possible <span style="color: #548235; mso-themecolor: accent6; mso-themeshade: 191; mso-style-textfill-fill-color: #548235; mso-style-textfill-fill-themecolor: accent6; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">pathological Q waves </span>in the precordial leads: V<sub>1</sub> through V<sub>4</sub>.<span style="mso-spacerun: yes;">&nbsp; </span>If this represents old anterior wall M.I., that would explain the poor R wave progression.</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt; color: #548235; mso-themecolor: accent6; mso-themeshade: 191; mso-style-textfill-fill-color: #548235; mso-style-textfill-fill-themecolor: accent6; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">Discussion<span style="mso-spacerun: yes;">&nbsp; </span></span></strong><span style="font-size: 12.0pt;">This patient has definitely earned a trip to the cath lab.<span style="mso-spacerun: yes;">&nbsp; </span>The <span style="color: #548235; mso-themecolor: accent6; mso-themeshade: 191; mso-style-textfill-fill-color: #548235; mso-style-textfill-fill-themecolor: accent6; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">ST elevations in related leads II, III, and aVF</span> with expected <span style="color: #548235; mso-themecolor: accent6; mso-themeshade: 191; mso-style-textfill-fill-color: #548235; mso-style-textfill-fill-themecolor: accent6; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">reciprocal changes in Leads I and aVL </span>are indicative of <span style="color: #548235; mso-themecolor: accent6; mso-themeshade: 191; mso-style-textfill-fill-color: #548235; mso-style-textfill-fill-themecolor: accent6; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">Inferior Wall ST elevation M.I. (STEMI).</span><span style="mso-spacerun: yes;">&nbsp; </span>The rate is faster than we would like to see in an injured heart, and attempts will be made to slow it with medication.<span style="mso-spacerun: yes;">&nbsp; </span>The ST depression in the precordial leads could have several causes, including subendocardial ischemia.<span style="mso-spacerun: yes;">&nbsp; </span>It is common to see LOCALIZED ST depression in V<sub>1</sub>, V<sub>2</sub>, and V<sub>3</sub> with inferior wall M.I., indicating extension of the damaged tissue up the posterior wall.<span style="mso-spacerun: yes;">&nbsp; </span>The patient’s preexisting pulmonary disease could also be causing ST changes, as well as the poor R wave progression and the arrhythmia.<span style="mso-spacerun: yes;">&nbsp; </span>Sadly, we do not have a previous ECG for comparison, or any information on the patient’s outcome.</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 12.0pt;"><strong>For teaching purposes</strong>, this ECG is excellent for illustrating the difference between wide QRS and tall ST elevation.<span style="mso-spacerun: yes;">&nbsp; </span>Since all four channels on this ECG are run simultaneously, we only have to compare the QRS complexes that look “wide” (II and III) to the complexes directly above (I), and we will see that the ST segment is masquerading as a wide QRS.</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;">&nbsp;</p><p class="MsoNormal"><em style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; line-height: 107%;">We are providing one image marked up in Dr. Ken Grauer’s signature style, and also a “clean” copy for those who wish to reproduce it without the labels.</span></em></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 12.0pt;"><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/19/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 Inferior Wall M.I. With Atrial Fibrillation 1/5</option><option value="40">Give Inferior Wall M.I. With Atrial Fibrillation 2/5</option><option value="60">Give Inferior Wall M.I. With Atrial Fibrillation 3/5</option><option value="80" selected="selected">Give Inferior Wall M.I. With Atrial Fibrillation 4/5</option><option value="100">Give Inferior Wall M.I. With Atrial Fibrillation 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.5</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--3" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-mSjOSY-7qR5jyG-_gAZm15i03MNDoMrwGfPCq-qqV1o" /> <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/inferior-mi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Inferior M.I.</a></div><div class="field-item odd"><a href="/ecg/stemi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">STEMI</a></div><div class="field-item even"><a href="/ecg/st-elevation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ST elevation</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/posterior-mi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Posterior M.I.</a></div><div class="field-item odd"><a href="/ecg/fib" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">A Fib</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%2Finferior-wall-mi-atrial-fibrillation&amp;title=Inferior%20Wall%20M.I.%20With%20Atrial%20Fibrillation%20"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 24 Feb 2019 04:17:52 +0000 Dawn 765 at https://www.ecgguru.com https://www.ecgguru.com/ecg/inferior-wall-mi-atrial-fibrillation#comments ECG Basics: Onset of Atrial Fibrillation https://www.ecgguru.com/ecg/ecg-basics-onset-atrial-fibrillation <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-onset-atrial-fibrillation"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/162%20A%20Fib%20onset.jpg" width="1769" height="325" 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 shows the onset of atrial fibrillation. &nbsp;A fib can be "paroxysmal," meaning that it has a sudden onset, but then stops spontaneously, usually within 24 hours to a week. &nbsp;A fib can also be classified as "persistent", meaninging that the a fib lasts more than a week. &nbsp;It can stop spontaneously, or be halted with medical treatment. &nbsp;"Permanent" a fib is a fib that is resistent to treatment. &nbsp;</p><p>The first three beats in this strip represent sinus rhythm at 75 beats per minute. &nbsp;At the onset of atrial fibrillation with beat number four, the rhythm becomes irregularly irregular, and the rate is around 140-150 bpm. We can expect new-onset a fib to have a fast ventricular rate, as the atria are sending hundreds of impulses to the AV node every minute. The AV node will conduct as many of those impulses as it can to the ventricles. &nbsp;Most AV nodes can easily transmit 130-160 bpm. &nbsp;In a fib, the atria are quivering, not contracting. Because of this fibrillation of the atrial muscle, a fib has no P waves, and therefore, no "atrial kick". &nbsp;The contribution of the atria to cardiac output (25-30%) is lost. An extremely fast rate can also lower output and overwork the heart, so one treatment goal for a fib is to lower the rate. &nbsp;This can be done independently of attempts to convert the rhythm.</p><p>During a fib, blood clots can form in parts of the atria, especially the left atrial appendage. &nbsp;If sinus rhythm is restored after these thrombi form, they can embolize and travel to the brain, causing stroke. &nbsp;Before electively converting atrial fib to a sinus rhythm, the patient may need to be anticoagulated.</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/19/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 ECG Basics: Onset of Atrial Fibrillation 1/5</option><option value="40">Give ECG Basics: Onset of Atrial Fibrillation 2/5</option><option value="60">Give ECG Basics: Onset of Atrial Fibrillation 3/5</option><option value="80">Give ECG Basics: Onset of Atrial Fibrillation 4/5</option><option value="100" selected="selected">Give ECG Basics: Onset of Atrial Fibrillation 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--4" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-vGzk5Wtt9fpx7Zd9QSMW-UFkH5d4y8WHvbzkWMzX00E" /> <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-fibrillation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial fibrillation</a></div><div class="field-item odd"><a href="/ecg/fib" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">A Fib</a></div><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/rhythm-strip" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Rhythm strip</a></div><div class="field-item even"><a href="/ecg/basic-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Basic ECG</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%2Fecg-basics-onset-atrial-fibrillation&amp;title=ECG%20Basics%3A%20%20Onset%20of%20Atrial%20Fibrillation"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sat, 17 Dec 2016 01:44:09 +0000 Dawn 719 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-onset-atrial-fibrillation#comments ECG Basics: Atrial Fibrillation With A Rapid Ventricular Response https://www.ecgguru.com/ecg/ecg-basics-atrial-fibrillation-rapid-ventricular-response-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/ecg-basics-atrial-fibrillation-rapid-ventricular-response-2"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/157%20A%20Fib.jpg" width="1784" height="216" 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 rhythm strip has all the hallmarks of atrial fibrillation: &nbsp;the rhythm is irregularly irregular and there are no P waves. &nbsp;The rate is about 150 beats per minute. There is no P wave because the atria are being irregularly depolarized by many ectopic pacemakers at once, causing the atria to "quiver". &nbsp;This patient has new-onset atrial fib, and has been medicated with a calcium channel blocker. &nbsp;The rate shows signs of slowing, but has not reached the target rate for this patient of less than 80 bpm.</p><p>At the onset of atrial fib, the rate is usually fast, because the AV node is being bombarded by numerous impulses from the atria. &nbsp;The impulses arrive irregularly, and with different "strengths". &nbsp;The AV node conducts as many impulses as it is able to, usually resulting in a rate over 110-120 bpm. &nbsp;Medications can affect the rate, of course, and we use medications to slow AV conduction and allow a more normal heart rate. &nbsp;</p><p>There are many methods of correcting atrial fib, not always with permanent success. Some patients tolerate this rhythm well as long as the rate is kept in check. &nbsp;But others suffer a loss of cardiac output due to the loss of "atrial kick", which is the forceful filling of the ventricles by the contracting atria. &nbsp;This loss of cardiac output can severely impair some people, making it necessary to try to convert the atrial fibrillation. &nbsp;In addition, people living with atrial fib must be anticoagulated, as the loss of forceful emptying of the atria can cause collections of blood clots which can break free and embolize.</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/19/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: Atrial Fibrillation With A Rapid Ventricular Response 1/5</option><option value="40">Give ECG Basics: Atrial Fibrillation With A Rapid Ventricular Response 2/5</option><option value="60">Give ECG Basics: Atrial Fibrillation With A Rapid Ventricular Response 3/5</option><option value="80">Give ECG Basics: Atrial Fibrillation With A Rapid Ventricular Response 4/5</option><option value="100" selected="selected">Give ECG Basics: Atrial Fibrillation With A Rapid Ventricular Response 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 >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-Nls6SyBLNIpPHtCAhJivEWnNRXlD5G5U9Foaj8JEUko" /> <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-fibrillation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial fibrillation</a></div><div class="field-item odd"><a href="/ecg/fib" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">A Fib</a></div><div class="field-item even"><a href="/ecg/rhythm-strip" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Rhythm strip</a></div><div class="field-item odd"><a href="/ecg/basic-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Basic ECG</a></div><div class="field-item even"><a href="/ecg/ecg-basics" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ECG Basics</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-atrial-fibrillation-rapid-ventricular-response-2&amp;title=ECG%20Basics%3A%20%20Atrial%20Fibrillation%20With%20A%20Rapid%20Ventricular%20Response"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sat, 19 Dec 2015 05:11:51 +0000 Dawn 681 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-atrial-fibrillation-rapid-ventricular-response-2#comments ECG Basics: Atrial Fibrillation With a Rapid Ventricular Response https://www.ecgguru.com/ecg/ecg-basics-atrial-fibrillation-rapid-ventricular-response-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/ecg-basics-atrial-fibrillation-rapid-ventricular-response-1"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/154%20Atrial%20fib.jpg" width="1800" height="414" 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 rhythm strip is recorded in two simultaneous leads, which is always preferable to one single lead. &nbsp;It is a good example of atrial fibrillation with a rapid ventricular response. &nbsp;Atrial fib that has not been treated will usually have a rapid ventricular rate. &nbsp;This reflects the ability of the AV node to conduct a tachycardia, within limits. &nbsp;The natural slow conduction of the AV node allows it to act as a "filter", preventing the huge numbers of impulses generated by the atrial fibrillation from reaching the ventricles. &nbsp;In this case, about 140 beats per minute are able to make it through the AV node into the ventricles. &nbsp; In some patients, preexisting cardiac conditions such as valve insufficiency or CHF may make this rate dangerous for the patient. &nbsp;The rate may lower cardiac output in some people, and this must be considered in light of the fact that the loss of P waves in atrial fib also lowers cardiac output significantly.</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/19/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 ECG Basics: Atrial Fibrillation With a Rapid Ventricular Response 1/5</option><option value="40">Give ECG Basics: Atrial Fibrillation With a Rapid Ventricular Response 2/5</option><option value="60">Give ECG Basics: Atrial Fibrillation With a Rapid Ventricular Response 3/5</option><option value="80" selected="selected">Give ECG Basics: Atrial Fibrillation With a Rapid Ventricular Response 4/5</option><option value="100">Give ECG Basics: Atrial Fibrillation With a Rapid Ventricular Response 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--6" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-Ot4GF0iSgQeYkTBBLsBAy5g64qcreaS63c7Jhj5ID2M" /> <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/basic-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Basic ECG</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/atrial-fibrillation-rapid-ventricular-response-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial fibrillation with a rapid ventricular response</a></div><div class="field-item even"><a href="/ecg/fib" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">A Fib</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_6"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fecg-basics-atrial-fibrillation-rapid-ventricular-response-1&amp;title=ECG%20Basics%3A%20%20Atrial%20Fibrillation%20With%20a%20Rapid%20Ventricular%20Response"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 26 Jul 2015 19:54:22 +0000 Dawn 654 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-atrial-fibrillation-rapid-ventricular-response-1#comments ECG Basics: Atrial Fibrillation With Rapid Ventricular Response https://www.ecgguru.com/ecg/ecg-basics-atrial-fibrillation-rapid-ventricular-response-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/ecg-basics-atrial-fibrillation-rapid-ventricular-response-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/127%20Atrial%20Fib%20With%20Rapid%20Response.jpg" width="1800" height="281" 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 rhythm strip to use to illustrate how atrial fibrillation can almost look regular when the rate is fast. &nbsp;Students should be taught how to "march out" the rhythm for regularity. &nbsp;It is always a good idea with atrial fib to take a longer strip, looking for the inevitable "gaps" in the R-to-R intervals. &nbsp;Also, as your students progress, a 12-lead ECG is invaluable to really search for P waves. &nbsp;Even two or three simultaneous leads are better than just one.</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/19/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 ECG Basics: Atrial Fibrillation With Rapid Ventricular Response 1/5</option><option value="40">Give ECG Basics: Atrial Fibrillation With Rapid Ventricular Response 2/5</option><option value="60" selected="selected">Give ECG Basics: Atrial Fibrillation With Rapid Ventricular Response 3/5</option><option value="80">Give ECG Basics: Atrial Fibrillation With Rapid Ventricular Response 4/5</option><option value="100">Give ECG Basics: Atrial Fibrillation With Rapid Ventricular Response 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3</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--7" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-HKX-HoG6NGLn-Vs6MzsA7B-EBUEB2bpyrmOTDcUJ_-4" /> <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/fib" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">A Fib</a></div><div class="field-item even"><a href="/ecg/basic-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Basic ECG</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/atrial-fibrillation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial fibrillation</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%2Fecg-basics-atrial-fibrillation-rapid-ventricular-response-0&amp;title=ECG%20Basics%3A%20%20Atrial%20Fibrillation%20With%20Rapid%20Ventricular%20Response"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Thu, 13 Mar 2014 16:54:03 +0000 Dawn 560 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-atrial-fibrillation-rapid-ventricular-response-0#comments ECG Basics: Atrial Fibrillation With A Controlled Ventricular Response https://www.ecgguru.com/ecg/ecg-basics-atrial-fibrillation-controlled-ventricular-response <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-atrial-fibrillation-controlled-ventricular-response"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/122%20A%20Fib%20controlled%20response.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>Atrial fibrillation with a controlled ventricular response is often considered to be atrial fib that has been controlled with medication. &nbsp;While this is often true, it is possible to see atrial fib with a ventricular rate between 50 and 100 bpm in a patient who has not been treated. &nbsp;The hallmark signs of atrial fib are: &nbsp;<strong>no P waves</strong> and<strong> irregularly-irregular rhythm.</strong></p><p>Multiple, simultaneous leads are advised to be sure there are no P waves, and a long rhythm strip is often needed to prove the irregularly-irregular rhythm. &nbsp;Remember, even though this rate is adequate (about 90 bpm), the loss of P waves means no "atrial kick". &nbsp;The atria are not filling the ventricles with a forceful pumping action. Patients can lose a significant percentage - up to 25% - of their cardiac output because of this. &nbsp;Coupled with the risk of stroke from the formation and embolization of blood clots from the sluggish circulation in the atria, it is much preferable to have sinus rhythm at the same rate.</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/19/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 ECG Basics: Atrial Fibrillation With A Controlled Ventricular Response 1/5</option><option value="40">Give ECG Basics: Atrial Fibrillation With A Controlled Ventricular Response 2/5</option><option value="60">Give ECG Basics: Atrial Fibrillation With A Controlled Ventricular Response 3/5</option><option value="80" selected="selected">Give ECG Basics: Atrial Fibrillation With A Controlled Ventricular Response 4/5</option><option value="100">Give ECG Basics: Atrial Fibrillation With A Controlled Ventricular Response 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.7</span></span> <span class="total-votes">(<span >12</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-rhzP34Jqc4dSCtnaoEvCkJ0pc5ZJYU07avcjJgOet2o" /> <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/fib" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">A Fib</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/basic-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Basic ECG</a></div><div class="field-item even"><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_8"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fecg-basics-atrial-fibrillation-controlled-ventricular-response&amp;title=ECG%20Basics%3A%20%20Atrial%20Fibrillation%20With%20A%20Controlled%20Ventricular%20Response"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Mon, 25 Nov 2013 07:07:58 +0000 Dawn 519 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-atrial-fibrillation-controlled-ventricular-response#comments ECG Challenge From Dr. Ahmed - Patient With Hyperkalemia https://www.ecgguru.com/ecg/ecg-challenge-dr-ahmed-patient-hyperkalemia <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-dr-ahmed-patient-hyperkalemia"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AFib%20from%20Dr.%20Ahmed.jpg" width="1800" height="1279" 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 kindly donated to the ECG Guru website by Dr. Ahmed for open discussion among our members. &nbsp;The patient was a 70+ year-old man who presented with a complaint of dizziness. &nbsp;His serum potassium level was found to be 6.5 (normal is 3.5 - 5.0). &nbsp;Upon correction of his K levels, his rhythm was atrial fibrillation at 130 / min.</p><p>WHAT DO YOU THINK ABOUT THIS INITIAL ECG? &nbsp;What is causing the slow rate? Is there atrial activity? &nbsp;Do you see QRS morphology changes? &nbsp;What about the anterior ST and T wave changes?&nbsp;</p><p>We look forward to hearing from our members! &nbsp;And thanks to Dr. Ahmed for donating this interesting ECG.</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/19/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 ECG Challenge From Dr. Ahmed - Patient With Hyperkalemia 1/5</option><option value="40">Give ECG Challenge From Dr. Ahmed - Patient With Hyperkalemia 2/5</option><option value="60">Give ECG Challenge From Dr. Ahmed - Patient With Hyperkalemia 3/5</option><option value="80">Give ECG Challenge From Dr. Ahmed - Patient With Hyperkalemia 4/5</option><option value="100" selected="selected">Give ECG Challenge From Dr. Ahmed - Patient With Hyperkalemia 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 >3</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-BdJ13lBzZTprqRIuLoYByKRAVWRZKoisVUdBHGULfvo" /> <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/bradycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Bradycardia</a></div><div class="field-item odd"><a href="/ecg/fib" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">A Fib</a></div><div class="field-item even"><a href="/ecg/hyperkalemia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Hyperkalemia</a></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%2Fecg%2Fecg-challenge-dr-ahmed-patient-hyperkalemia&amp;title=ECG%20Challenge%20From%20Dr.%20Ahmed%20-%20Patient%20With%20Hyperkalemia"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Fri, 26 Jul 2013 22:03:56 +0000 Dawn 472 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-challenge-dr-ahmed-patient-hyperkalemia#comments ECG Basics: Atrial Fibrillation With Rapid Ventricular Response https://www.ecgguru.com/ecg/ecg-basics-atrial-fibrillation-rapid-ventricular-response <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-atrial-fibrillation-rapid-ventricular-response"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/105%20A%20Fib%20Rapid%20Resp.jpg" width="1800" height="357" 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 basic rhythm strip example of atrial fibrillation with a rapid ventricular response showing the identifying characteristics of atrial fibrillation: &nbsp;no P waves, an irregularly-irregular rhythm, and a "fibrillatory" baseline. &nbsp;The wavy baseline will not be seen in all leads in all patients, so it is best to use the first two findings as diagnostic criteria. &nbsp;Atrial fib often appears initially as a rapid rhythm, as the AV node is being bombarded by many impulses from multiple foci (pacemakers) in the atria. &nbsp;Depending upon the AV node's ability to transmit these impulses,however, we could see a slow, normal, or rapid ventricular response.&nbsp;</p><p>Atrial fib has very chaotic depolarization of the atrial muscle, resulting in quivering and ineffective pumping of the atria. &nbsp;This loss of "atrial kick" can severely reduce ventricular filling, and can reduce cardiac output by as much as 25%. &nbsp;In patients with a very rapid rate, cardiac output can be further reduced, causing CHF. &nbsp;In addition, the fibrillating atria can form blood clots due to sluggish movement of blood. &nbsp;These clots can embolize and cause stroke. &nbsp;For these reasons, patients with atrial fib are anticoagulated and sometimes the atrial fib is stopped by medical, surgical, or electrical therapy. &nbsp;Recurrence of atrial fib is common after treatment, and for some patients, control of the ventricular rate and anticoagulation become the preferred treatment.</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/19/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 ECG Basics: Atrial Fibrillation With Rapid Ventricular Response 1/5</option><option value="40">Give ECG Basics: Atrial Fibrillation With Rapid Ventricular Response 2/5</option><option value="60">Give ECG Basics: Atrial Fibrillation With Rapid Ventricular Response 3/5</option><option value="80" selected="selected">Give ECG Basics: Atrial Fibrillation With Rapid Ventricular Response 4/5</option><option value="100">Give ECG Basics: Atrial Fibrillation With Rapid Ventricular Response 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 >12</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-WqCX4j7qvVf-LCfI0Y985RPko8U49WO6CUBsKN5AIn8" /> <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/fib" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">A Fib</a></div><div class="field-item odd"><a href="/ecg/ecg-basics" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ECG Basics</a></div><div class="field-item even"><a href="/ecg/basic-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Basic ECG</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/atrial-fibrillation-rapid-ventricular-response-1" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial fibrillation with rapid ventricular response</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_10"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fecg-basics-atrial-fibrillation-rapid-ventricular-response&amp;title=ECG%20Basics%3A%20%20Atrial%20Fibrillation%20With%20Rapid%20Ventricular%20Response"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Thu, 06 Jun 2013 04:46:52 +0000 Dawn 454 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-atrial-fibrillation-rapid-ventricular-response#comments