tag:blogger.com,1999:blog-18943510.post6263596976269797612..comments2023-08-21T02:57:37.362-05:00Comments on Dr. Wes: Speed RecordDrWeshttp://www.blogger.com/profile/17438019699222125477noreply@blogger.comBlogger18125tag:blogger.com,1999:blog-18943510.post-25471045371949182662008-03-12T21:43:00.000-05:002008-03-12T21:43:00.000-05:00I love posts like these. Reminds me why EP is so m...I love posts like these. Reminds me why EP is so much fun.<BR/><BR/>-EP/Cath Lab TechDavidAhttps://www.blogger.com/profile/17271631071542474451noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-39893264387583757042008-03-06T14:23:00.000-06:002008-03-06T14:23:00.000-06:00Wow, I'm getting so excited by all of this EP-spea...Wow, I'm getting so excited by all of this EP-speak! Thanks, Jay and anony!<BR/><BR/>One thing I have learned in medicine is "never say 'never'." I just don't know at this point if the AV node in <I>this</I> patient can physiologically conduct this fast or not. I have seen very rapid conduction in our EP labs with healthy young patients on Isuprel, but I agree with Jay that this rate <I>de DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-73131379874017943812008-03-06T13:44:00.000-06:002008-03-06T13:44:00.000-06:00Anonymous,In preexcited Afib, all QRS complexes ne...Anonymous,<BR/><BR/>In preexcited Afib, all QRS complexes need not be wide. <BR/> <BR/>Consider that both the AV node and the accessory pathway are barraged by rapid stimuation. Each of these conducting pathways have their own block cycle and not every impulse will get through. If the pathway happens to block at a time that the AV node conducts, the resultant complex will be narrow. <BR/><BR/>Jayhttps://www.blogger.com/profile/10897176780069403370noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-29035389199330404162008-03-06T10:58:00.000-06:002008-03-06T10:58:00.000-06:00jay-do you see narrow qrs complexes at slower rate...jay-<BR/>do you see narrow qrs complexes at slower rates and then wider complexes at higher rates in preexcited afib? i can understand why pathways may not conduct at higher rates than lower rates, but i am not sure why the reverse should occur? why would the pathway suddenly start to conduct?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-91104201590507303082008-03-06T10:10:00.000-06:002008-03-06T10:10:00.000-06:00Wow! I wonder how many ER visits are SNOW SHOVELI...Wow! I wonder how many ER visits are SNOW SHOVELING related? Whether it be cardiac events like this one, hip fractures from falling on the ice, or the dreaded back strain from heavy lifting of the snow.<BR/>On another note, do you have any comment on Baxter's Heparin supply?<BR/>An article is on the front page of the Chicago Tribune 3/6/8. Thanks!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-55269084279509358682008-03-06T09:07:00.000-06:002008-03-06T09:07:00.000-06:00Wes,What would you think about giving a shot of ad...Wes,<BR/><BR/>What would you think about giving a shot of adenosine in sinus rhythm to exclude latent preexcitation? If the patient is young and has enhanced AV nodal conduction, the delta wave may not be apparent on a resting ECG. That strip seems a little too fast for AV nodal conduction to me (unless your patient is actually a hummingbird).<BR/><BR/>I guess if you have afib recorded on otherJayhttps://www.blogger.com/profile/10897176780069403370noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-87030962175894067482008-03-06T08:52:00.000-06:002008-03-06T08:52:00.000-06:00Take a young individual with atrial fibrillation, ...Take a young individual with atrial fibrillation, add some wet packed snow, and have ‘em work real hard, and you can get what’s seen here. (Incidentally, this occurred the same day I strained my back!)<BR/><BR/>This telemetry strip is rapidly-conducted atrial fibrillation via the AV node. All of this patient’s EKGs failed to demonstrated evidence of pre-excitation. This person was shoveling DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-62986878901541073242008-03-06T08:49:00.000-06:002008-03-06T08:49:00.000-06:00Jay said: "Looks like afib with a bypass tract con...Jay said: "Looks like afib with a bypass tract conducting antegrade to me."<BR/><BR/>Then a-fib with WPW would fit that definition, correct?<BR/><BR/>Because that's what I was going to say...Ambulance Driverhttps://www.blogger.com/profile/10175419709184526342noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-31300751186759992842008-03-05T22:21:00.000-06:002008-03-05T22:21:00.000-06:00Thanks to all who've chimed in so far. Just so ot...Thanks to all who've chimed in so far. Just so others "across the pond" can view this, I'll post my interpretation here tomorrow AM...DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-20805073568026935542008-03-05T21:15:00.000-06:002008-03-05T21:15:00.000-06:00I'm going with WPW, not because that's what I thin...I'm going with WPW, not because that's what I think it is, but because I've always wanted to use WPW as an answer on a test.Patrickhttps://www.blogger.com/profile/10681011337931740108noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-33713796417570958012008-03-05T21:08:00.000-06:002008-03-05T21:08:00.000-06:00Looks like afib with a bypass tract conducting ant...Looks like afib with a bypass tract conducting antegrade to me. Would love to see a twelve lead in sinus rhythm. I'm surprised no one else has guessed this already. Am I the only electrophysiologist who reads this site?????Jayhttps://www.blogger.com/profile/10897176780069403370noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-64626782763425432692008-03-05T20:35:00.000-06:002008-03-05T20:35:00.000-06:00Agree with anonymous. Too fast for v tach; native...Agree with anonymous. Too fast for v tach; native rate of atrial flutter is usually around 350 as is seen here. Rate-related conduction delay would explain the wide complexes.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-14048490960641825192008-03-05T20:00:00.000-06:002008-03-05T20:00:00.000-06:00a flutter 1:1 with aberrant conductiona flutter 1:1 with aberrant conductionAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-23648011257988258712008-03-05T18:37:00.000-06:002008-03-05T18:37:00.000-06:00It almost looks like runs of vfib with runs a afib...It almost looks like runs of vfib with runs a afib with aberrancy. <BR/><BR/>Wouldn't that be strange to have both rhythms simultaneosly?The Happy Hospitalisthttps://www.blogger.com/profile/14392872203166584371noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-51345847059845000332008-03-05T18:09:00.000-06:002008-03-05T18:09:00.000-06:00afib conducted aberrantly when it really gets goin...afib conducted aberrantly when it really gets goingAblate This!https://www.blogger.com/profile/03835353799229337582noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-68917277443268585472008-03-05T17:14:00.000-06:002008-03-05T17:14:00.000-06:00Clue: It's not noise or interference...Clue: It's not noise or interference...DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-22195971205715788172008-03-05T16:24:00.000-06:002008-03-05T16:24:00.000-06:00Interference? Someone tapping on the leads?Interference? Someone tapping on the leads?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-81605616069455860502008-03-05T16:11:00.000-06:002008-03-05T16:11:00.000-06:00"So, what is it?": Extreme vtach?!"So, what is it?": Extreme vtach?!Anonymousnoreply@blogger.com