AV Block in a tachycardic rhythm? 
Episode 74
January 28, 2013
AV Block in a tachycardic rhythm? 
Episode 74
January 28, 2013

Can you have a Mobitz I in a tachycardic patient?? You’ll have an answer in 11min.

Don’t trust the computer’s EKG interpretation…that’s your job!

  • Computer may commonly miss p-waves that are buried in the T-waves.
  • AV Dissociation can be seen in BOTH fast and slow rhythms.
  • When in doubt, map out atrial beats with calipers and search for buried p-waves.
Right Bundle Branch Block
Right Bundle Branch Block
Episode 73
January 22, 2013

Got questions about RBBB? Get some answers in 11 minutes.

ANY ST-ELEVATION IN RBBB IS ALWAYS ABNORMAL!
No special criteria need to be met to have STEMI in RBBB
Uncomplicated RBBB
  • QRS duration > 120ms
  • Tall R wave or R’ in V1 & V2 (conversely, LBBB has an S waves in V1 & V2)
  • ”Wide-ish” S waves in the lateral leads
  • Expected ST-depression and TWI in V1-V3

Concordant STE is BAD! Don’t forget that you can dignose STEMI even in the setting of LBBB or paced rhythms. Watch these for a refersher…
 

 
Isorhythmic AV Dissociation vs. Complete Heart Block
Episode 72
January 14, 2013

This week is a tough one!

Is AV dissociation the same thing as complete heart block? And what does it mean when the P-waves are “flirting” with the QRS complexes? You’ll know in 16 minutes!

Isorhythmic AV Dissociation vs. Complete Heart Block
Episode 72
January 14, 2013

This week is a tough one!

Is AV dissociation the same thing as complete heart block? And what does it mean when the P-waves are “flirting” with the QRS complexes? You’ll know in 16 minutes!

AV dissociation (AVD) is not the same thing as complete heart block (CHB)

  • AVD simply means that the atrium and ventricles are beating regularly, but doing their own thing.
  • Isorhythmic AVD exists when the atrium and ventricles are beating regularly but doing their own thing, just at a very similar rate. It can be a normal variant.
  • In CHB, no atrial beats are being conducted to the ventricles.
  • AVD without CHB exists (some atrial beats conducted to ventricle), and is identified by changing QRS morphologies.​
  • Look closely at PR-intervals and watch for different QRS morphologies to see if atrial beats are being conducted. 

Review more on AV blocks here…

 
 
 
 
Differences in the Pediatric ECG
Episode 71
January 7, 2013

Is it RVH? Is it pre-excitation? Is it a PE? Or is it just a KID?! Give this case 13 minutes of your time and you’ll learn how kids try to fool us!
 
Normal average resting heart rate
- Newborn (1st month) = 150 bpm
- 1-3 years: 120 bpm
- 3-5 years: 110 bpm
- 5-8 years:100 bpm
- Max rate with sinus tachycardia is generally (220-Age) bpm
 

Common Differences in the Pediatric ECG

  • The PR & QRS intervals tend to be shorter (QRS <80ms before age 8) and this is normal. Consider Ventricular Tachycardia when QRS is >90ms.
  • Rightward axis (large R wave in V1-V2, small S wave in V5-V6) is due to RV predominance and normalizes as the left ventricle thickens.
  • Small narrow Q-waves in inferior and lateral leads (pseudo-infarction pattern, but benign). Pathologic Q-waves are 1 box (40ms) wide.
  • Juvenile T-wave abnormalities (TWI in V1-V3 through age 8 is normal)
Differences in the Pediatric ECG
Episode 71
January 7, 2013

Is it RVH? Is it pre-excitation? Is it a PE? Or is it just a KID?! Give this case 13 minutes of your time and you’ll learn how kids try to fool us!
 
Normal average resting heart rate
- Newborn (1st month) = 150 bpm
- 1-3 years: 120 bpm
- 3-5 years: 110 bpm
- 5-8 years:100 bpm
- Max rate with sinus tachycardia is generally (220-Age) bpm
 

Common Differences in the Pediatric ECG

  • The PR & QRS intervals tend to be shorter (QRS <80ms before age 8) and this is normal. Consider Ventricular Tachycardia when QRS is >90ms.
  • Rightward axis (large R wave in V1-V2, small S wave in V5-V6) is due to RV predominance and normalizes as the left ventricle thickens.
  • Small narrow Q-waves in inferior and lateral leads (pseudo-infarction pattern, but benign). Pathologic Q-waves are 1 box (40ms) wide.
  • Juvenile T-wave abnormalities (TWI in V1-V3 through age 8 is normal)
 

If you see kids in your practice, you must master the pediatric ECG. Check out this previous episode for more pediatrics…

 
 
 
 
Role of ECG in the patient with a new “seizure”
Role of ECG in the patient with a new “seizure”
Episode 67
December 10, 2012

 


Check an ECG on patients with seizures? Why?

Always check for dysrhythmia in patients who present with their first “seizure”
  • The PR interval is key in distinguishing between the specific type of AV nodal blockade
  • Do you remember what to look for when you are evaluating an ECG in the patient with syncope? 


Be the expert when it comes to interpreting the ECG for your patients with syncope. Here are some relevant previous episodes…

Can’t miss ECG’s in syncope

ECG findings in Hypertrophic Cardiomyopathy

Brugada Syndrome

Syncope and prolonged QT-intervals