tag:blogger.com,1999:blog-18943510.post4383882597012557993..comments2023-08-21T02:57:37.362-05:00Comments on Dr. Wes: EKG Du Jour #22: A Rare ClassicDrWeshttp://www.blogger.com/profile/17438019699222125477noreply@blogger.comBlogger14125tag:blogger.com,1999:blog-18943510.post-82472618772411920362011-08-20T00:02:13.257-05:002011-08-20T00:02:13.257-05:00Congrats to all of you who recognized the regular ...Congrats to all of you who recognized the regular wide complex rhythm with alternating axes which define bidirectional ventricular tachycardia. (Yes, it truely is a regular rhythm - print it out to see).<br /><br />Of interest, this patient was NOT on digoxin. Note that both QRS morphologies seen in this tachycardia have a RBBB morphology (predominant R wave in V1) suggesting this arrhythmia DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-50733056936901087202011-08-19T19:35:06.581-05:002011-08-19T19:35:06.581-05:00By the way, I have posted another example of bidir...By the way, I have posted another example of bidirectional tachycardia here: http://hqmeded-ecg.blogspot.com/search/label/bidirectional%20tachycardia<br /><br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-81113007164837548052011-08-19T19:34:08.016-05:002011-08-19T19:34:08.016-05:00Looks to me like bidirectional tachycardia. This ...Looks to me like bidirectional tachycardia. This is a regular rhythm, so cannot be atrial fibrillation. Ashmann's phenomenon happens mostly in atrial fib or with premature atrial contractions. It happens if a beat comes directly after a previous long R-R interval; the refractory period after this long R-R interval is prolonged, and so the next beat, though supraventricular (a fib or PAC), Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-665563121967888142011-08-19T18:23:04.117-05:002011-08-19T18:23:04.117-05:00Gonna say sinus rhythm RBBB rate around 100 using ...Gonna say sinus rhythm RBBB rate around 100 using large block method with PVC's in bigeminny. I see P waves in lead I and AVF (zoom in)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-68472957798945621722011-08-19T17:16:02.836-05:002011-08-19T17:16:02.836-05:00Nice catch in all leads! (of bidirectional VT..)Nice catch in all leads! (of bidirectional VT..)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-76859834431872067602011-08-19T17:11:31.891-05:002011-08-19T17:11:31.891-05:00Bidirectional VT. Too old for Catecholaminergic Po...Bidirectional VT. Too old for Catecholaminergic Polymorphic Ventricular Tachycardia, so prob. digitalis toxicity or reentry?Dr Gilles Delmigliohttps://www.blogger.com/profile/13606488884090654617noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-6244252615886401282011-08-19T16:48:18.883-05:002011-08-19T16:48:18.883-05:00hmm. i'm inclined to go with a bigeminal acce...hmm. i'm inclined to go with a bigeminal accelerated junctional rhythm. ashman's doesn't seem right due to the regularity of the rhythm...as for VT, isn't the rate too slow? just curious and my 2 cents.<br /><br />can't wait to find out the answer.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-53617167144630489582011-08-19T16:46:26.817-05:002011-08-19T16:46:26.817-05:00hmm. ugly, for sure! i don't think it's ...hmm. ugly, for sure! i don't think it's ashman's due to regularity; i'm inclined to go with a bigeminal junctional rhythm of sorts. as for VT, is the rate too slow to be considered VT? <br /><br />can't wait to find out!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-72609859850825884562011-08-19T16:20:19.228-05:002011-08-19T16:20:19.228-05:00Definitely bigeminal rhythm. width and morphology ...Definitely bigeminal rhythm. width and morphology suggest a RBBB, axis appears normal. Inverted T-waves in inferior and precordial leads suggestive of ischemia.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-755548613050380582011-08-19T15:47:18.096-05:002011-08-19T15:47:18.096-05:00Nice catch on all leads!! (of bidirectional VT..)Nice catch on all leads!! (of bidirectional VT..)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-67687128449309562012011-08-19T14:17:21.843-05:002011-08-19T14:17:21.843-05:00Junctional rhythm with bigeminy?Junctional rhythm with bigeminy?Jonathanhttps://www.blogger.com/profile/09750678604152330765noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-43243820512265263232011-08-19T13:53:50.284-05:002011-08-19T13:53:50.284-05:00BI-directional VT concerning for dig toxicityBI-directional VT concerning for dig toxicityAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-23768413056629123462011-08-19T13:53:07.065-05:002011-08-19T13:53:07.065-05:00Bi-directional VT = dig toxicity?Bi-directional VT = dig toxicity?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-33883662829856006712011-08-19T12:53:17.206-05:002011-08-19T12:53:17.206-05:00Hopefully this EP rotation has paid off... Is it A...Hopefully this EP rotation has paid off... Is it Ashman phenomenon?andrewhttps://www.blogger.com/profile/15145965448685624401noreply@blogger.com