tag:blogger.com,1999:blog-18943510.post7118851034148272103..comments2023-08-21T02:57:37.362-05:00Comments on Dr. Wes: EKG Du Jour - #9DrWeshttp://www.blogger.com/profile/17438019699222125477noreply@blogger.comBlogger13125tag:blogger.com,1999:blog-18943510.post-589998647673294942008-07-15T04:34:00.000-05:002008-07-15T04:34:00.000-05:00Good Job! :)Good Job! :)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-2745512708420033142008-06-30T10:26:00.000-05:002008-06-30T10:26:00.000-05:00Nice ECG and good explanation in the comments!Nice ECG and good explanation in the comments!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-64749900231251785322008-06-18T09:54:00.000-05:002008-06-18T09:54:00.000-05:00Wes-Great ECG, and an EP classic. I would add that...Wes-<BR/>Great ECG, and an EP classic. I would add that while the response to carotid sinus massage confirms the diagnosis, it really is not absolutely necessary--there is enough information even in the 2:1 block segment. Specifically, proximal block in the AV node is a phenomenon of high vagal tone (assuming you're not in the EP lab pacing the atrium at really fast rates). In this case, the Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-3791667639767025962008-06-16T22:19:00.000-05:002008-06-16T22:19:00.000-05:00Almost tried this on a pt today to put my new foun...Almost tried this on a pt today to put my new found knowledge into practice.<BR/>Saw him in nuc med for his p-myo.<BR/>He was in 2:1 AV block with a rate in the mid 40s. Really wanted to try the carotid massage, but decided I couldn't justify it because he already has a pending appt for pacer implantation. <BR/>CardioNPAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-73361957335944419982008-06-14T11:03:00.000-05:002008-06-14T11:03:00.000-05:00What a great EKG. What is the CPT code for caroti...What a great EKG. What is the CPT code for carotid massage? I bet it pays a $1000 bucks. Also, be careful with the Bundle of His. You don't want any feminists claiming discrimination. How about the gender neutral Bundle of HermyThe Happy Hospitalisthttps://www.blogger.com/profile/14392872203166584371noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-54251613508442774912008-06-13T13:31:00.000-05:002008-06-13T13:31:00.000-05:00rw donnell-Nice work! This was an interesting cas...rw donnell-<BR/><BR/>Nice work! <BR/><BR/>This was an interesting case I encountered some time ago. The clinical question was: is this Mobitz I proximal 2:1 AV nodal block (which might not need a pacemaker) or Mobitz II 2:1 (distal) AV nodal block that should have a pacemaker? In this case, carotid sinus massage was used to differentiate the two forms of AV block.<BR/><BR/>An easy way to DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-88434016354741619692008-06-13T09:53:00.000-05:002008-06-13T09:53:00.000-05:00One more point I'd like to make---The more I think...One more point I'd like to make---<BR/>The more I think about this tracing the more interesting it is. It's a good example of how artificial the concepts of "block" and "degree of block" really are. This patient went from "second degree block" to "no block" although his conduction system did not improve one iota. The lesson is that conduction ratio must always be considered in the context of Robert W Donnellhttps://www.blogger.com/profile/16944231400440786271noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-87321742030391813712008-06-13T09:04:00.000-05:002008-06-13T09:04:00.000-05:00Initially 2:1 block. Although with 2:1 conduction...Initially 2:1 block. Although with 2:1 conduction one can't apply the classic criteria to distinguish type 1 from type 2 block (no consecutively conducted beats seen prior to drop)it's virtually certain this is type 2 evidenced by LBBB. Moreover, type 1 block would get worse with vagal maneuvers.<BR/><BR/>Tissues at the level of the block (His-Purkenje)have all or none conduction (absolute Robert W Donnellhttps://www.blogger.com/profile/16944231400440786271noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-84996202498763690212008-06-13T07:31:00.000-05:002008-06-13T07:31:00.000-05:00I'm still trying to figure out the reason for a ca...I'm still trying to figure out the reason for a carotid massage...Patrickhttps://www.blogger.com/profile/10681011337931740108noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-41585578065676155992008-06-12T19:36:00.000-05:002008-06-12T19:36:00.000-05:00It looked to me as if the carotid massage slowed t...It looked to me as if the carotid massage slowed the sinus rate to the point where you have 1:1 conduction, rather than 2:1. <BR/><BR/>There is a problem with the conduction system. The sinus node is attempting to initiate beats that, as Yoni wrote, are during the refractory period. By slowing the sinus node, all of the impulses fall outside of repolarization and are conducted. So the rate Rogue Medichttps://www.blogger.com/profile/07598646309630074992noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-42852779458543032532008-06-12T17:43:00.000-05:002008-06-12T17:43:00.000-05:00Paramedic here:Definitely a 2nd degree AV Block. I...Paramedic here:<BR/>Definitely a 2nd degree AV Block. I believe it is Winky based on the response to the Vagal Maneuver. (I've only been reading this blog for a few months, can I assume that youtube video has already been posted?)<BR/><BR/>From my understanding, the second p wave in each cycle does not conduct to the ventricles as it falls during the Effective Refractory Period of the Action Yonihttps://www.blogger.com/profile/03621328288673602086noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-40101354136483166222008-06-12T17:30:00.000-05:002008-06-12T17:30:00.000-05:00eyedoc-For clarification, the carotid massage begi...eyedoc-<BR/><BR/>For clarification, the carotid massage begins half way through the strip and continues throughout the right half of the rhythm strip shown.DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-47156843546124615332008-06-12T16:58:00.000-05:002008-06-12T16:58:00.000-05:00Can an ophthalmologist try: Appears to be in 2:1 b...Can an ophthalmologist try: Appears to be in 2:1 block at first (cannot see any vertical grid marks so can't tell rate), with p-p interval lengthening with each cycle. Carotid massage drops ventricular rate, and atrial beats return out of sync with what they were before the carotid massage caused the shrt asystolic period. That's as far as I can go with it (Also assume lbbb since name of image isAnonymousnoreply@blogger.com