ECG Guru - Instructor Resources - Defibrillation https://www.ecgguru.com/ecg/defibrillation en Acute Anterior M.I. and Ventricular Fibrillation https://www.ecgguru.com/ecg/acute-anterior-mi-and-ventricular-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/acute-anterior-mi-and-ventricular-fibrillation"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/032923%20AWMI%20from%20Travis%20Britt%2015%20Lead%201446%20Ed.jpg" width="1800" height="645" alt="" /></a></div><div class="field-item odd"><a href="/ecg/acute-anterior-mi-and-ventricular-fibrillation"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/032923%20AWMI%20from%20Travis%20Britt%2012%20Lead%201449%20Ed.jpg" width="1800" height="621" alt="" /></a></div><div class="field-item even"><a href="/ecg/acute-anterior-mi-and-ventricular-fibrillation"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/032923%20AWMI%201451%20VF%20to%20shock%20ed_0.jpg" width="1800" height="845" alt="" /></a></div><div class="field-item odd"><a href="/ecg/acute-anterior-mi-and-ventricular-fibrillation"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/032923%20Cath%20lab%20image%20100%20%25%20LAD%20small%20for%20Guru.jpg" width="597" height="642" 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="text-align: left; line-height: normal;" align="left"><strong><span style="font-size: 12.0pt; color: #538135; mso-themecolor: accent6; mso-themeshade: 191;">The Patient:</span></strong><span style="font-size: 12.0pt;"><span style="mso-spacerun: yes;">&nbsp;&nbsp; </span>This series of ECGs is from a 65-year-old woman who was complaining of a sudden onset of chest pain, nausea, and weakness. She stated that the pain increased on inspiration.<span style="mso-spacerun: yes;">&nbsp; </span>She reported a history of non-insulin-dependent diabetes mellitus (NIDDM).</span><strong><span style="font-size: 12.0pt; color: #538135; mso-themecolor: accent6; mso-themeshade: 191;">&nbsp;</span></strong></p><p class="MsoNormal" style="text-align: left; line-height: normal;" align="left"><strong><span style="font-size: 12.0pt; color: #538135; mso-themecolor: accent6; mso-themeshade: 191;">ECG No. 1, 14:46:</span></strong><span style="font-size: 12.0pt;"><span style="mso-spacerun: yes;">&nbsp; </span>This ECG includes V4Right, V8 and V9 in place of V4, V5, and V6.<span style="mso-spacerun: yes;">&nbsp; </span>The rhythm is sinus at 91 beats per minute.<span style="mso-spacerun: yes;">&nbsp; </span>The PR interval is within normal limits, as is the QRS duration.<span style="mso-spacerun: yes;">&nbsp; </span>The QTc is WNL as well.<span style="mso-spacerun: yes;">&nbsp; </span>The frontal plane axis is also WNL.<span style="mso-spacerun: yes;">&nbsp; </span>The three standard chest leads show an early transition of R waves in V2. <span style="mso-spacerun: yes;">&nbsp;&nbsp;</span>There are noticeable ST and T wave abnormalities:</span></p><p class="MsoNormal" style="text-align: left; line-height: normal;" align="left"><span style="font-size: 12.0pt;">slight ST elevation in I and aVL with ST depression in II, III, and aVF.<span style="mso-spacerun: yes;">&nbsp; </span>In chest pain, possible M.I., STD should be presumed to be reciprocal in nature.<span style="mso-spacerun: yes;">&nbsp; </span>V1 has slight STE with a coved upward (frowning) appearance.<span style="mso-spacerun: yes;">&nbsp; </span>V2 has more noticeable STE, with a tall, wide-based T wave. This is called a “hyperacute T wave”.<span style="mso-spacerun: yes;">&nbsp; </span>We will have to evaluate V4 – V6 on ECG No. 2.<span style="mso-spacerun: yes;">&nbsp; </span></span></p><p class="MsoNormal" style="text-align: left; line-height: normal;" align="left"><span style="font-size: 12.0pt;">V4 Right has no ST elevation, and V8 and V9 have ST depression (reciprocal to the anterior leads).<span style="mso-spacerun: yes;">&nbsp; </span>So far, we have all the signs of <strong>acute anterior wall M.I.</strong></span><strong><span style="font-size: 12.0pt; color: #538135; mso-themecolor: accent6; mso-themeshade: 191;">&nbsp;</span></strong></p><p class="MsoNormal" style="text-align: left; line-height: normal;" align="left"><strong><span style="font-size: 12.0pt; color: #538135; mso-themecolor: accent6; mso-themeshade: 191;">ECG No. 2, 14:49:</span></strong><strong><span style="font-size: 12.0pt;"><span style="mso-spacerun: yes;">&nbsp; </span></span></strong><span style="font-size: 12.0pt;">This ECG, taken three minutes later, includes the 12 “standard” leads.<span style="mso-spacerun: yes;">&nbsp; </span>The ST depression in the inferior wall has increased slightly. There is not much change in the anterior STE.<span style="mso-spacerun: yes;">&nbsp; </span>There is movement artifact in the first half of the ECG.<span style="mso-spacerun: yes;">&nbsp; </span>Leads V5 and V6 show STD.&nbsp;</span><span style="font-size: 12pt;">&nbsp;</span></p><p class="MsoNormal" style="text-align: left; line-height: normal;" align="left"><strong><span style="font-size: 12.0pt; color: #538135; mso-themecolor: accent6; mso-themeshade: 191;">Rhythm Strip at 14:51:</span></strong><span style="font-size: 12.0pt;"> Shows v fib, and a 360 J defibrillation that resulted in sinus tach with wide QRS complexes.<span style="mso-spacerun: yes;">&nbsp; </span>The rhythm just before the v fib was more “organized” looking, with regular, fast QRS complexes of varying heights, as seen in the first half of the rhythm strip, but this rhythm deteriorated very quickly.<span style="mso-spacerun: yes;">&nbsp;</span></span><span style="font-size: 12pt;">&nbsp;</span></p><p class="MsoNormal" style="text-align: left; line-height: normal;" align="left"><strong><span style="font-size: 12.0pt; color: #538135; mso-themecolor: accent6; mso-themeshade: 191;">Learning Points:<span style="mso-spacerun: yes;">&nbsp; </span></span></strong><span style="font-size: 12.0pt;">This patient was dramatically symptomatic, but her ECG signs of M.I. might have seemed subtle to the inexperienced viewer.<span style="mso-spacerun: yes;">&nbsp; </span>It is important to be very systematic in looking at ECGs, and ST changes particularly.<span style="mso-spacerun: yes;">&nbsp; </span>The ECG machine aided us by measuring ST elevations and depressions, and it is easily seen that these signs occur in “related leads”.<span style="mso-spacerun: yes;">&nbsp; </span>Localization of ST elevation is a very accurate sign of <strong>ACUTE ST ELEVATION M.I. <span style="mso-spacerun: yes;">&nbsp;&nbsp;</span></strong>Additional leads should probably be done after the standard 12.<span style="mso-spacerun: yes;">&nbsp; </span>RVMI is rare in anterior wall M.I., as the RV is supplied by the right coronary artery, and the anterior LV wall is usually supplied by the left anterior descending artery.<span style="mso-spacerun: yes;">&nbsp; </span>Posterior leads can confirm posterior wall M.I. if it is suspected by the presence of ST <em>depression</em> in V1 – V3.<span style="mso-spacerun: yes;">&nbsp; </span></span></p><p class="MsoNormal" style="text-align: left; line-height: normal;" align="left"><span style="font-size: 12.0pt;">There was some discussion about whether the sudden-onset wide-complex tachycardia could be <a href="https://emedicine.medscape.com/article/1950863-overview">Torsades de pointes</a>.<span style="mso-spacerun: yes;">&nbsp; </span>TdP can only be diagnosed in the setting of <strong>long QTc</strong>, which was not noted in the first two ECGs.<span style="mso-spacerun: yes;">&nbsp; </span><a href="https://pubmed.ncbi.nlm.nih.gov/11583899/">Polymorphic VT in the setting of acute M.I. is usually associated with ischemia, not QT prolongation.</a><span style="mso-spacerun: yes;">&nbsp; </span>It can be very hard to determine the point at which polymorphic VT becomes V Fib, but clinically, it does not matter.<span style="mso-spacerun: yes;">&nbsp; </span>The patient needs to be defibrillated.</span><span style="font-size: 12pt;">&nbsp;</span></p><p class="MsoNormal" style="text-align: left; line-height: normal;" align="left"><strong><span style="font-size: 12.0pt; color: #538135; mso-themecolor: accent6; mso-themeshade: 191;">Follow up:</span></strong><span style="font-size: 12.0pt;"><span style="mso-spacerun: yes;">&nbsp; </span>The patient was taken to the cath lab within 45 minutes of EMS patient contact. She was found to have a proximal 100% occlusion of the left anterior descending branch. Angioplasty was successful, and we have no further information.</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/390/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 Acute Anterior M.I. and Ventricular Fibrillation 1/5</option><option value="40">Give Acute Anterior M.I. and Ventricular Fibrillation 2/5</option><option value="60">Give Acute Anterior M.I. and Ventricular Fibrillation 3/5</option><option value="80" selected="selected">Give Acute Anterior M.I. and Ventricular Fibrillation 4/5</option><option value="100">Give Acute Anterior M.I. and Ventricular Fibrillation 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 >6</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-tb1A8Jns5uCdkhmvAlkt0MaqYJOlWcGDApS1f9kfDRM" /> <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/awmi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">AWMI</a></div><div class="field-item odd"><a href="/ecg/st-elevation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ST elevation</a></div><div class="field-item even"><a href="/ecg/anterior-mi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Anterior 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/ventricular-fibrillation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ventricular fibrillation</a></div><div class="field-item odd"><a href="/ecg/v-fib-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">V Fib</a></div><div class="field-item even"><a href="/ecg/hyperacute-t-waves" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Hyperacute T waves</a></div><div class="field-item odd"><a href="/ecg/defibrillation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Defibrillation</a></div><div class="field-item even"><a href="/ecg/cath-lab-images" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Cath lab images</a></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%2Fecg%2Facute-anterior-mi-and-ventricular-fibrillation&amp;title=%20Acute%20Anterior%20M.I.%20and%20Ventricular%20Fibrillation"><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, 04 Apr 2023 21:11:57 +0000 Dawn 837 at https://www.ecgguru.com https://www.ecgguru.com/ecg/acute-anterior-mi-and-ventricular-fibrillation#comments Atrial Fib To Cardiac Arrest https://www.ecgguru.com/ecg/atrial-fib-cardiac-arrest <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-fib-cardiac-arrest"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AF%20Pre%20Torsades%2012%20Lead.jpg" width="1800" height="741" alt="" /></a></div><div class="field-item odd"><a href="/ecg/atrial-fib-cardiac-arrest"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Rhythm%20strips%20cropped%20for%20Guru.jpg" width="1800" height="1018" 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: 10pt; line-height: 107%; font-family: 'Calibri Light', sans-serif; color: #222222; background-image: initial; background-attachment: initial; background-size: initial; background-origin: initial; background-clip: initial; background-position: initial; background-repeat: initial;">A paramedic crew responded to the office of a local physician. A 61-year-old male presented with a one-week history of chest pain and shortness of breath. He had a previously undiagnosed atrial fibrillation with rapid ventricular response and left bundle branch block, but was alert. Shortly after transport commenced, the patient became unresponsive with Torsades de Pointes, which rapidly degenerated into ventricular fibrillation. The paramedic placed pads and defibrillated<span class="apple-converted-space">&nbsp;within one minute. &nbsp;After two minutes of compressions, the patient had a fairly regular rhythm with return of spontaneous circulation. &nbsp;Transport time was short. &nbsp;On catheterization, the patient was found to have severe coronary artery disease, requiring coronary artery bypass graft surgery (CABG) A balloon pump was inserted in an attempt to strengthen him for surgery.</span></span></p> <p class="MsoNormal"><strong><span style="font-size: 10pt; line-height: 107%; font-family: 'Calibri Light', sans-serif; color: #222222; background-image: initial; background-attachment: initial; background-size: initial; background-origin: initial; background-clip: initial; background-position: initial; background-repeat: initial;">What is the rhythm? &nbsp;&nbsp;</span></strong><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">The 12-lead ECG presented here shows atrial fibrillation at a rate of 138 per minute.</span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">&nbsp; </span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">The rhythm is irregularly-irregular with no P waves.</span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">&nbsp; </span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">Since the patient had not yet been diagnosed with atrial fib, obviously no therapy had been initiated to control the rate. There is a PVC near the end of the strip.</span></p> <p class="MsoNormal"><strong><span style="font-size: 10pt; line-height: 107%; font-family: 'Calibri Light', sans-serif; color: #222222; background-image: initial; background-attachment: initial; background-size: initial; background-origin: initial; background-clip: initial; background-position: initial; background-repeat: initial;">Why is the QRS complex wide? &nbsp;</span></strong><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">The QRS complex is wide at 0.168 sec (168 ms).</span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">&nbsp; </span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">It meets the ECG criteria for<a title="LBBB Criteria" href="http://ecgguru.com/ecg/left-bundle-branch-block-0"> left bundle branch block</a> (wide QRS, supraventricular rhythm, negative V</span><sub style="color: #222222; font-family: 'Calibri Light', sans-serif; line-height: 107%;">1</sub><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;"> and positive Leads I and V</span><sub style="color: #222222; font-family: 'Calibri Light', sans-serif; line-height: 107%;">6</sub><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">). Atrial fibrillation can lower cardiac output because there is no P wave, and therefore, no “atrial kick”. Left BBB can lower cardiac output because a wide QRS is a sign of unsynchronized depolarization of the ventricular muscle, which causes less pumping force. To help you determine if a rhythm is LBBB or VT, review <a title="Brugada Criterion" href="http://ecgguru.com/ecg/brugada-criterion">Brugada's Criterion</a>.</span></p> <p class="MsoNormal"><strong><span style="font-size: 10pt; line-height: 107%; font-family: 'Calibri Light', sans-serif; color: #222222; background-image: initial; background-attachment: initial; background-size: initial; background-origin: initial; background-clip: initial; background-position: initial; background-repeat: initial;">Are there ST changes? &nbsp;</span></strong><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">In <a title="Sgarbossa" href="http://ecgguru.com/ecg/sgarbossa-criteria">wide-complex rhythms</a>, it can be difficult to determine whether acute M.I. is present, because the wide QRS is normally accompanied by “discordant ST changes”.</span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">&nbsp; </span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">That is, if the QRS is positive, the ST and T wave are negative. If the QRS is negative, the ST and T will be elevated.</span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">&nbsp; </span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">In this ECG, there is a subtle ST elevation in Leads III and aVR, and subtle ST depression in I and aVL.</span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">&nbsp; </span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">It is difficult to attribute this to A.M.I., but subsequent events point to that as the diagnosis.</span></p> <p class="MsoNormal"><strong><span style="font-size: 10pt; line-height: 107%; font-family: 'Calibri Light', sans-serif; color: #222222; background-image: initial; background-attachment: initial; background-size: initial; background-origin: initial; background-clip: initial; background-position: initial; background-repeat: initial;">What about the rhythm strips that follow? &nbsp;&nbsp;</span></strong><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">The rhythm strips provided show the patient’s quick progression, during transport to the hospital, from atrial fib with PVCs to <a title="Torsades" href="http://ecgguru.com/ecg/torsades-de-pointes">Torsades de Pointes</a>, to V Fib.</span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">&nbsp; </span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">They show an electrical shock at 200 joules approximately 1 minute after the VT started.</span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">&nbsp; </span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">This shock successfully converted the patient’s rhythm.</span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">&nbsp; </span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">First, it appears that the rhythm may be atrial flutter with 4:1 conduction (or it may be baseline artifact).</span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">&nbsp; </span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">By the final strip shown, we see a regular rhythm without clear P waves at a rate of 50 bpm.</span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">&nbsp; </span><span style="color: #222222; font-family: 'Calibri Light', sans-serif; font-size: 10pt; line-height: 107%;">This could be a junctional rhythm, difficult to assess with only a 2-lead rhythm strip.</span><span style="color: #222222; font-family: Arial, sans-serif; font-size: 10pt; line-height: 107%;">&nbsp;</span></p> <h3 class="MsoNormal"><span style="font-size: 10pt; line-height: 107%; color: #222222; background-image: initial; background-attachment: initial; background-size: initial; background-origin: initial; background-clip: initial; background-position: initial; background-repeat: initial;"><strong>This series provides many teaching opportunities.</strong>&nbsp; </span></h3> <p class="MsoNormal"><span style="font-size: 10pt; line-height: 107%; color: #222222; background-image: initial; background-attachment: initial; background-size: initial; background-origin: initial; background-clip: initial; background-position: initial; background-repeat: initial;">1) Both atrial fib with LBBB and VT can cause a WIDE-COMPLEX TACHYCARDIA. </span></p> <p class="MsoNormal"><span style="font-size: 10pt; line-height: 107%; color: #222222; background-image: initial; background-attachment: initial; background-size: initial; background-origin: initial; background-clip: initial; background-position: initial; background-repeat: initial;">2) It can be difficult to see the classic signs of STEMI when BBB is present.</span></p> <p class="MsoNormal"><span style="font-size: 10pt; line-height: 107%; color: #222222; background-image: initial; background-attachment: initial; background-size: initial; background-origin: initial; background-clip: initial; background-position: initial; background-repeat: initial;">3) VT can progress VERY RAPIDLY to V Fib, especially in low-output conditions.</span></p> <p class="MsoNormal"><span style="font-size: 10pt; line-height: 107%; color: #222222; background-image: initial; background-attachment: initial; background-size: initial; background-origin: initial; background-clip: initial; background-position: initial; background-repeat: initial;">4) Effective chest compressions and quick defibrillation will often result in conversion to an organized rhythm.&nbsp; Defibrillating the perfused heart is infinitely more effective that shocking a poorly-perfused heart.<strong> Kudos to this crew for a job well done.</strong></span><span style="font-size: 10.0pt; line-height: 107%; mso-bidi-font-family: Arial; color: #222222;"><br> </p> <!--[if !supportLineBreakNewLine]--><p><br> </p> <!--[endif]--><p></span></p> <p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">&nbsp;</span></p> <p>&nbsp;</p> <p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">&nbsp;</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/390/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 Fib To Cardiac Arrest 1/5</option><option value="40">Give Atrial Fib To Cardiac Arrest 2/5</option><option value="60">Give Atrial Fib To Cardiac Arrest 3/5</option><option value="80" selected="selected">Give Atrial Fib To Cardiac Arrest 4/5</option><option value="100">Give Atrial Fib To Cardiac Arrest 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 >10</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-keELmaO-wl_oZyKtp-HhpYDSu1ALgPLAbKoFXfeoHHA" /> <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/teaching-series" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Teaching series</a></div><div class="field-item odd"><a href="/ecg/ivcd" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">IVCD</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/left-bundle-branch-block-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left bundle branch block</a></div><div class="field-item even"><a href="/ecg/torsades-de-pointes" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Torsades de Pointes</a></div><div class="field-item odd"><a href="/ecg/v-fib-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">V Fib</a></div><div class="field-item even"><a href="/ecg/v-tach" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">V Tach</a></div><div class="field-item odd"><a href="/ecg/ventricular-fibrillation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ventricular fibrillation</a></div><div class="field-item even"><a href="/ecg/ventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ventricular tachycardia</a></div><div class="field-item odd"><a href="/ecg/defibrillation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Defibrillation</a></div><div class="field-item even"><a href="/ecg/junctional-rhythm" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Junctional rhythm</a></div><div class="field-item odd"><a href="/ecg/acute-mi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Acute M.I.</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-fib-cardiac-arrest&amp;title=Atrial%20Fib%20To%20Cardiac%20Arrest"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 03 Jul 2016 20:31:52 +0000 Dawn 705 at https://www.ecgguru.com https://www.ecgguru.com/ecg/atrial-fib-cardiac-arrest#comments ECG Basics: Ventricular Fibrillation Converted With Defibrillation https://www.ecgguru.com/ecg/ecg-basics-ventricular-fibrillation-converted-defibrillation <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-ventricular-fibrillation-converted-defibrillation"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/133%20V%20Fib%20converted_0.jpg" width="1871" height="401" 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>A good example of ventricular fibrillation converted by electric defibrillation to what appears to be a sinus rhythm. &nbsp;There is significant artifact in the post-conversion strip, but the last beat on the strip appears to have a P-QRS-T sequence.</p><p>Of course, V Fib presents without pulses, and must be defibrillated as soon as possible. &nbsp;Best results are achieved by defibrillating a perfused heart, so if there is any delay from onset of V Fib, CPR should be performed to perfuse the heart prior to defibrillation.</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/390/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 ECG Basics: Ventricular Fibrillation Converted With Defibrillation 1/5</option><option value="40">Give ECG Basics: Ventricular Fibrillation Converted With Defibrillation 2/5</option><option value="60">Give ECG Basics: Ventricular Fibrillation Converted With Defibrillation 3/5</option><option value="80">Give ECG Basics: Ventricular Fibrillation Converted With Defibrillation 4/5</option><option value="100" selected="selected">Give ECG Basics: Ventricular Fibrillation Converted With Defibrillation 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.5</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--3" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-pOm8MbrQQRo8V9K2yd-2jJyWtlazFg7d1ghzuEUzm9E" /> <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/ventricular-fibrillation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ventricular fibrillation</a></div><div class="field-item odd"><a href="/ecg/v-fib-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">V Fib</a></div><div class="field-item even"><a href="/ecg/vf" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">VF</a></div><div class="field-item odd"><a href="/ecg/defibrillation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Defibrillation</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_3"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fecg-basics-ventricular-fibrillation-converted-defibrillation&amp;title=ECG%20Basics%3A%20%20Ventricular%20Fibrillation%20Converted%20With%20Defibrillation"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 07 Sep 2014 02:48:32 +0000 Dawn 597 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-ventricular-fibrillation-converted-defibrillation#comments 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><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/390/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: NIPS Procedure, ICD Test 1/5</option><option value="40">Give ECG Basics: NIPS Procedure, ICD Test 2/5</option><option value="60">Give ECG Basics: NIPS Procedure, ICD Test 3/5</option><option value="80" selected="selected">Give ECG Basics: NIPS Procedure, ICD Test 4/5</option><option value="100">Give ECG Basics: NIPS Procedure, ICD Test 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 >7</span> votes)</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-Qr-qaEUNL9vxLf2NYrmIhmXJo_PdrneETzoJNiZQWoI" /> <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/rhythm-strip" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Rhythm strip</a></div><div class="field-item even"><a href="/ecg/nips-procedure" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">NIPS Procedure</a></div><div class="field-item odd"><a href="/ecg/icd-test" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ICD Test</a></div><div class="field-item even"><a href="/ecg/pacemaker" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pacemaker</a></div><div class="field-item odd"><a href="/ecg/cardioversion" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Cardioversion</a></div><div class="field-item even"><a href="/ecg/defibrillation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Defibrillation</a></div><div class="field-item odd"><a href="/ecg/ventricular-fibrillation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ventricular fibrillation</a></div><div class="field-item even"><a href="/ecg/vf" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">VF</a></div><div class="field-item odd"><a href="/ecg/paced-rhythm" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Paced rhythm</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-nips-procedure-icd-test&amp;title=ECG%20Basics%3A%20%20NIPS%20Procedure%2C%20ICD%20Test"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Fri, 27 Sep 2013 19:20:52 +0000 Dawn 499 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-nips-procedure-icd-test#comments