tag:blogger.com,1999:blog-18943510.post5278684862465045393..comments2023-08-21T02:57:37.362-05:00Comments on Dr. Wes: EKG Du Jour #15: What's Inside?DrWeshttp://www.blogger.com/profile/17438019699222125477noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-18943510.post-45632112554692346472009-04-22T01:04:00.000-05:002009-04-22T01:04:00.000-05:00An EKG done during a heart attack may look normal ...An EKG done during a heart attack may look normal or unchanged from a previous EKG. Do we need to repeat the EKG to look for changes? What do you suggest? Preparing for surgery Aortic replacement and Root Repair next month at Valve Replacement New York.Susan Diazhttp://www.empowereddoctor.com/doctor_index_7336.htmlnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-64428885704600913652009-04-10T14:05:00.000-05:002009-04-10T14:05:00.000-05:00I have seen this a number of times in older patien...I have seen this a number of times in older patients with previous surgeries or previous ablations in RA. My guess is that if the RA lead was septal, say cs ostium, one might see the flutter waves??Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-64372504973330463922009-04-08T13:47:00.000-05:002009-04-08T13:47:00.000-05:00Oops, sorry about the typo - Karel Frederik Wencke...Oops, sorry about the typo - Karel Frederik <B>Wenckebach</B> is rolling over in his grave....DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-25358517179744178292009-04-08T13:45:00.000-05:002009-04-08T13:45:00.000-05:00The tracing above was obtained by inhibiting the o...The tracing above was obtained by inhibiting the output of the pacemaker to see patient’s underlying rhythm and the right atrial signal present at the local atrial electrogram. At first, it was thought the surface EKG findings were artifact, so multiple leads were evaluated and all showed the same atypical atrial flutter pattern on the surface EKG. The right atrial electrogram however, is DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-27270781633592711632009-04-07T18:21:00.000-05:002009-04-07T18:21:00.000-05:00The electrogram and marker channel don't seem to r...The electrogram and marker channel don't seem to reflect the flutter waves. I don't know what the atrial lead is actually sensing, but something may be wrong with it, maybe a dislodgement or an insulation break. But I can't fully explain the tracings.Robert W Donnellhttps://www.blogger.com/profile/16944231400440786271noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-81089283283661780472009-04-07T17:41:00.000-05:002009-04-07T17:41:00.000-05:00It looks like the atrial depolarizations are not c...It looks like the atrial depolarizations are not conducted, like a 2nd-degree AV block. I'd guess the atrial lead isn't "recognizing" the extra depolarizations due to the device's atrial refractory period; meaning the device is expecting a ventricular depol. after the atrial depol. and thus turns off sensing to prevent feedback. So I'd say it's an AV block and the device atrial refractory period James Lnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-73299972129856613552009-04-07T08:14:00.000-05:002009-04-07T08:14:00.000-05:00that's really weird. his surface tracing looks li...that's really weird. <BR/>his surface tracing looks like flutter, but there is no flutter on the marker channels or the atrial lead electrogram, and those seem to be consistent with irregular discrete atrial beats. they don't conduct to the ventricle with regularity, and there doesn't seem to be oversensing of the ventricular beat.<BR/>somehow the dilated atrium is creating channels or pathwaysAnonymousnoreply@blogger.com