Long QT Syndrome https://www.ecgguru.com/taxonomy/term/274/all en Long QT Syndrome,Look Closely and Do Not Trust the ECG-Computer https://www.ecgguru.com/blog/long-qt-syndromelook-closely-and-do-not-trust-ecg-computer <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/long-qt-syndromelook-closely-and-do-not-trust-ecg-computer"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/F15bZSaXsAM77DH.jpg" width="3686" height="1905" 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>ST-elevation V2/V3, why? The patient never had chest pain, echocardiography inconspicious. History of several syncopal episodes. But, there is something wrong with the ECG. We observe a sinus rhythm ECG, at first glance, there are ST-elevations in leads V2-V4. No ST-depressions are visible. Upon closer examination, a prominent T-wave is noted, starting immediately after the QRS complex. The ECG computer erroneously indicates a significantly shortened QT and QTc interval.</p></div></div></div> Wed, 26 Jul 2023 12:36:37 +0000 Dr A Röschl 853 at https://www.ecgguru.com ECG Basics: Torsades de Pointes https://www.ecgguru.com/ecg/ecg-basics-torsades-de-pointes <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-torsades-de-pointes"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/108%20Torsades%20de%20Pointes.jpg" width="1800" height="447" 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>Torsades de pointes, or polymorphic ventricular tachycardia, is a ventricular tachycardia precipitated by and associated with long QT Syndrome. &nbsp;Long QT Syndrome can be congenital or acquired. &nbsp;Torsades is life-threatening, and can be made worse by many drugs, including some of the drugs used to treat VT. &nbsp;The rate is usually 150 - 250 / min. and the appearance is of a wide-complex tachycardia with QRS morphology changes. &nbsp;In some leads, it will appear as if it is "twisting" around the isoelectric line, giving it the French name, Torsades de pointes, a ballet term meaning twisting of the points. &nbsp;For a thorough discussion of Torsades, check this <a title="Torsades de pointes" href="http://emedicine.medscape.com/article/1950863-overview#a1">LINK</a>.</p></div></div></div> Sat, 13 Jul 2013 18:30:12 +0000 Dawn 468 at https://www.ecgguru.com Third-degree AV Block and Junctional Escape Rhythm With Right Bundle Branch Block and Prolonged QTc Interval https://www.ecgguru.com/ecg/third-degree-av-block-and-junctional-escape-rhythm-right-bundle-branch-block-and-prolonged-qtc <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/third-degree-av-block-and-junctional-escape-rhythm-right-bundle-branch-block-and-prolonged-qtc"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AVB111_1.jpg" width="1699" height="1247" 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 70 year old woman for which we have, unfortunately, no clinical information.&nbsp; It shows a sinus rhythm with a rate of about 72 bpm (NSR) with AV dissociation caused by third-degree heart block.&nbsp; The escape rhythm is junctional at a rate of 38 bpm.&nbsp; There appears to be a right bundle branch block, based on the QRS duration of 132 ms, and a wide S wave in Leads I and V6.&nbsp; The precordial leads do not show the usual RBBB pattern of rSR' in V1 and V2, and the r wave progression is poor (non-existent).&nbsp; This is felt to be due to poor lead placement (a good teaching point).&nbsp; Of interest, the ECG machine has reported a "severe right axis deviation" based on the tall upright R wave in aVR and the deep S in avF.&nbsp; In RBBB, the first part of the QRS represents left ventricular depolarization, and the terminal wave represents the delayed right ventricle.&nbsp; In effect, the two ventricles have their own electrical axes, which we can see because the ventricles are not depolarizing simultaneously.&nbsp; The axis of the LV appears to be normal in this tracing.</p><p>In addition to the above, this patient has a very prolonged QT interval.&nbsp; The QT is longer in bradycardic rhythms, but when corrected to a standard of 60 bpm (QTc), this patient's QT interval is still prolonged at QTc: 552 ms.&nbsp; Without clinical data, we cannot speculate&nbsp; as to why this patient's QTc is prolonged, but it can be a very dangerous situation.&nbsp; Follow the links for more information on <a title="QT Prolongation and Torsades" href="http://www.medsafe.govt.nz/profs/PUArticles/DrugInducedQTProlongation.htm">QT prolongation</a> and Torsades de Pointes and <a title="Long QT Syndrome" href="http://emedicine.medscape.com/article/157826-overview">Long QT Syndrome</a>.</p><p>As always, we welcome comments from&nbsp;our members adding insight to this interesting ECG, and also questions you would like to ask our Guru members.</p></div></div></div> Sat, 26 Jan 2013 19:48:30 +0000 Dawn 396 at https://www.ecgguru.com