Cardioversion https://www.ecgguru.com/taxonomy/term/389/all en ECG Basics: Torsades Cardioverted https://www.ecgguru.com/ecg/ecg-basics-torsades-cardioverted <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-cardioverted"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/124%20Cardioversion%20of%20Torsades.jpg" width="1800" height="648" 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>These two strips are from one patient who was electrically cardioverted twice in a few minutes. &nbsp;The original reason for the cardioversion was Torsades de Pointes, a type of polymorphic ventricular tachycardia associated with a long QT interval. &nbsp;For more information about TDP, go to this<a title="Torsades" href="http://ecgguru.com/ecg/ecg-basics-torsades-de-pointes"> LINK.</a>&nbsp; It is a bit difficult to comment on the patient's post-cardioversion rhythm, because so little of it is shown. &nbsp;It appears to be sinus, with a wide QRS. &nbsp;The QT interval appears slightly prolonged at .44 sec, but it is not known what the QT interval is corrected to a rate of 60/min. &nbsp;TDP is often seen with QT intervals greater than 600 ms (.6 seconds). &nbsp;Also THESE STRIPS ARE NOT SIMULTANEOUS, they were taken two minutes apart. &nbsp;In the first one, the P waves and T waves look so much alike, they could all be P waves. &nbsp;They do not "march out". &nbsp;It is necessary to get a long strip, preferably in multiple leads, and a 12-Lead ECG, to properly evaluate the rhythm post-cardioversion.&nbsp;</p></div></div></div> Fri, 20 Dec 2013 19:08:13 +0000 Dawn 534 at https://www.ecgguru.com ECG Basics: NIPS Procedure, ICD Test https://www.ecgguru.com/ecg/ecg-basics-nips-procedure-icd-test <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-nips-procedure-icd-test"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/114%20NIPS%20Procedure.jpg" width="1800" height="213" 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 rhythm strip from a NIPS procedure (non-invasive programmed stimulaltion), which is a programming test for an implantable cardioverter defibrillator (ICD). &nbsp;The test is done under light anesthesia, similar to that used for colonoscopy. &nbsp; In this example, the patient is in normal sinus rhythm at the beginning of the procedure. &nbsp;The pacemaker technician overdrives the patient's rate to observe the pacing function, then a stimulus is delivered to cause ventricular fibrillation (V Fib). &nbsp;Initially, the ventricular rhythm is somewhat organized and coarse (V flutter), but it will rapidly deteriorate if not corrected. &nbsp;Before it deteriorates, the ICD delivers a shock, and the patient's rhythm is restored. &nbsp;In this example, bi-ventricular pacing was conducted for a few minutes before the patient resumed NSR. &nbsp;The patient is then recovered from the anesthesia and discharged home.</p><p>For your students, this is a good example of the relative safety of shocking the well-perfused heart. &nbsp;Although it is possible to put the heart into an intractable V Fib with this test, the ICD usually is able to convert the potentially lethal rhythm easily. &nbsp;It is a good reminder that we need to perfuse the heart well before performing defibrillation on a person with unwitnessed cardiac arrest.</p></div></div></div> Fri, 27 Sep 2013 19:20:52 +0000 Dawn 499 at https://www.ecgguru.com