Concealed conduction https://www.ecgguru.com/taxonomy/term/381/all en AV Block With Changing PR Intervals https://www.ecgguru.com/ecg/av-block-changing-pr-intervals <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/av-block-changing-pr-intervals"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Type%20II%20second%20deg%20with%20dual%20AV%20pathways.jpg" width="1800" height="708" 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"><span style="font-size: 12.0pt; line-height: 107%;">Just like other subjects we are taught in school, ECG interpretation is usually taught in a very basic, simplistic way.  As we add to our knowledge, we are able to determine the mechanisms of more complex rhythms.</span><span style="font-size: 12pt;"> </span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">When I took my first basic ECG rhythm monitoring course, I memorized all the “rules”, and at the end of the course, I thought I could read ANY strip correctly.  Then, in real life, I found that some rhythms can’t be interpreted from one lead, or even from one 12-lead ECG.</span><span style="font-size: 12pt;"> </span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">This strip offers advanced readers to challenge themselves, and it offers teachers a chance to show students an “exception to the rules” if it is appropriate for those students.  We all learn the classification of second-degree AV blocks:  Both Type I and Type II show an underlying sinus rhythm with some P waves conducted and some not.  Type I has progressively prolonging PR intervals until a P wave is non-conducted.  The cycle restarts after the dropped QRS.  Type II has PR intervals that are all the same, and may be prolonged or normal.</span><span style="font-size: 12pt;"> </span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">In this ECG, you will be able to “march out” a normal sinus rhythm at a rate of 80 bpm.  The P waves are marked with small dots at the bottom.  Two of every three P waves are followed by QRS complexes.  Is it Type I?  No – the PR intervals are not prolonging.  Is it Type II?  The PR intervals are not the same!  What is happening?</span><span style="font-size: 12pt;"> </span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">There is also left bundle branch block, which is a sub-Hisian block.  Blocks occurring in the intraventricular conduction system include bundle branch blocks, second-degree AVB Type II,  and third-degree AVB with ventricular escape.  This group of blocks tends to be more threatening than the blocks that occur in the AV node (second-degree type I and third-degree with junctional escape).</span><span style="font-size: 12pt;"> </span></p></div></div></div> Thu, 29 Sep 2016 03:23:59 +0000 Dawn 711 at https://www.ecgguru.com Jason's Blog: ECG Challenge of the month of November, 2013. https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-month-november-2013 <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/jasons-blog-ecg-challenge-month-november-2013"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Month%202s%20ladder1.png" width="788" height="509" 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>Sticking with the same general theme from my last <a href="http://ecgguru.com/ecg/atrial-flutter-31-v-conduction" target="_blank">ECG Challenge for the months of September and October, 2013</a>.&nbsp; This is more of a back-to-basics for some readers but will still challenge others.&nbsp; No information for this patient other than it was an adult.&nbsp; How would you interpret this? &nbsp;&nbsp;</p> </div></div></div> Sun, 17 Nov 2013 15:43:23 +0000 jer5150 518 at https://www.ecgguru.com Jason's Blog: ECG Challenge for the months of September and October, 2013. https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-months-september-and-october-2013 <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/jasons-blog-ecg-challenge-months-september-and-october-2013"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Month%202r%20ladder1.png" width="787" height="567" 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><span style="text-decoration: underline;"><strong>Patient's clinical data: </strong></span> 56-year old man. <br /><br />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. <br /></p></div></div></div> Sat, 14 Sep 2013 13:26:12 +0000 jer5150 493 at https://www.ecgguru.com