52 years old male with palpitations and dyspnea.










1. The first ECG finding of this ECG Case is non standard voltage calibration. Instead of 10mm/1mv, voltage calibration is done 5mm/1mv. Half standard calibration was used to prevent superposition of waveforms.
            At the beginning of the ECG recording, the ECG machine automatically performs a calibration while recording a rectangular shape signal with different amplitude.















Fig.1.The calibration signal (marked with red) has 5mm vertically. This show presence of half standard calibration (5mm/1mv), instead of 10mm/mV.




2. Basic normocardic sinus rhythm is interfered from a Ventricular Extrasystole (QRS nr. 4). This complex fulfills all criteria for Ventricular Extrasystole: QRS is wider than 0.12 s, is premature, followed by a compensatory pause and discordant ST.

              From QTS complex nr.7, begins a regular uniform wide complex tachycardia and continues until end of rhythm strips (QRS nr.24). Rhythm from 7-24 represents an episode of Monomorphic Ventricular Tachycardia with frequency ~180/min. Ventricular exstrasystole and Ventricular tachycardia have same morphology showing unifocal origin. 













Fig.2. VES (nr. 4) and VT (7-24) are marked with red.



3. Third significant finding is abnormal left axis deviation caused my Left Anterior Hemi Block (LAHB). qR pattern in I and aVL plus rS in II and III is quite enough to diagnose LAHB.















Fig.3. qr pattern in I and aVL plus rS in II and III (marked with red) in patient with abnormal left axis deviation diagnose LAHB.



Final diagnosis: Sinus rhythm. Monomorphic Ventricular Tachycardia. LAHB. Non standart voltage calibration.








Comments

Post a Comment

Popular posts from this blog

Sinus tachycardia vs Sinus bradycardia vs Sinus arrhythmia

Image
A) Sinus tachycardia is sinus rhythm with heart rate over 100/min. This rhythm is regular with normal appearance P wave and normal duration PR intervals. QRS complexes can be narrow or wide. B) Sinus bradycardia is sinus rhythm with heart rate bellow 60/min. This rhythm is regular with normal appearance P wave and normal duration PR intervals. QRS complexes can be narrow or wide. C) Sinus arrhythmia is sinus rhythm with variation of P-P (R-R) intervals at least 120ms. P wave has normal appearance and normal PR intervals. QRS complexes can be narrow or wide.
Read more

First degree vs Second degree vs Third degree AV Block

Image
Name this Blocks A. First degree AVB is present in this rhythm strip. Every P wave is conducted, but with prolonged PR interval (~320ms). B. Second degree AVB type 1 (Mobitz I) is present in this rhythm strip. We can see progressive prolongation of the PR interval culminating in a non-conducted P wave (3d and 7d P wave are non-conducted). C. Second degree AVB type 2:1 is present in this rhythm strip. We can see that there are 2P waves for every QRS complex. We don’t have two P wave conducted in a row so can’t conclude if PR interval is prolonged (Mobitz I) or constant (Mobitz II). D. High degree AVB (3:1) is present in this rhythm strip. We can see that just every 3d P wave is conducted (with constant PR interval) and two out of every three P wave are blocked. E. High degree AVB (4:1) is present in this rhythm strip. We can see that just every 4d P wave is conducted (with constant PR interval) and three out of every four wave are blocked. F. Third degree AVB is present i
Read more

What is the rhythm?

Image
The most probable diagnosis on those rhythm strips are as following: a) Sinus rhythm with wide QRS complexes. b) Atrial fibrilation with wide QRS complexes. c) PSVT (paroxysmal supraventricular tachycardia). d) WCT (most probable Ventricular tachycardia). e) Escape junctional rhythm
Read more