Amal Mattu’s ECG Case of the Week – April 20, 2015 To view the remainder of this post you must be logged in or have an ECGWeekly account. Log In Click here to purchase an annual account By ECGWeekly Support|2016-12-21T17:14:56-05:00April 20th, 2015|23 Comments Share This Story, Choose Your Platform! 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Thank you very much for all that you do! rohan mostert April 20, 2015 at 9:08 pmLog in to Reply Lots of ECG’s is good for my short attention span! Just a question for the long QT/ hypocalcemia case – the other thing that struck me on that is ECG was voltage – did the low voltage add validity to hypocalcemia or confuse things at all? No mention in the case of any other typical causes for the low voltage seen (infiltrative diseases, obesity, air/fluid effusions) Amal Mattu April 20, 2015 at 9:27 pmLog in to Reply Rohan: I didn’t care for the hypoCa patient so I’m not sure what the cause of LV was, but it’s not related to hypoCa. Obesity is the most common cause in our population. Amal Nate Zas April 20, 2015 at 10:56 pmLog in to Reply Definitely like multiple cases periodically. Its conducive to a more varied workout. Regarding low voltage, I’ve heard that only air and fluid reduce voltage, that fat conducts well and a patient has to be truly HUGE to show any LV. I don’t know if it’s true or not or what literature there is that may support that view… Michael Mitchell April 21, 2015 at 7:15 amLog in to Reply Occasional mixed case presentation is fun and an ECG meeting format is great. One case per week in great depth is brilliant and so informative. I’ve learned so much new information, especially with abnormalities that happen after the S wave. You rock!! Dr Michael Mitchell, ex Emergency Medicine Consultant, now in private general practice in London. Frédéric Picotte April 22, 2015 at 7:09 amLog in to Reply Like the idea of multiples cases “pot-pourri” once in a while, to hammer rapid key points. I would also appreciate some cases more in depth related to V tach dx and ddx, as well as cases of flutter versus sinus tach, always a pain when patient hovers close to 130-140… I am getting paranoid not to miss a flutter ! 😉 Fred jeffrey kasbohm April 22, 2015 at 1:16 pmLog in to Reply my vote for the pot-pourri thrown in occasionally with the as-in-the-past focused, single topic weekly. awesome! 🙂 Rudi Betancourt April 22, 2015 at 1:41 pmLog in to Reply First I’d like to say I’m a huge fan of your work. I am in total favor of the multiple case presentation due to the fact that they hammer the big points and to put it simply, the more ECG’s, the more knowledge we attain. Secondly, for the case you diagnosed as Ectopic atrial rhythm, could that be considered a borderline junctional rhythm/accelerated junctional rhythm? With a narrow QRS with inverted P waves at the rate of around 65. Unless the ectopic atrial rhythm essential encompasses those types of rhythms? Any clarification would be appreciated. Thank you for all you do! michael halberg April 22, 2015 at 2:41 pmLog in to Reply I vote potpourri style once every 3-6 weeks. This was really useful. Doug Smith April 22, 2015 at 6:05 pmLog in to Reply Any and all of the formats have been great. Amal, will you consider running for President of the United States?? Larry Moore April 23, 2015 at 4:05 amLog in to Reply I agree with the masses here. I like the occasional pot-pourri thrown out there. It’s a nice challenge without a theme leading my thought process. I would still prefer the “theme-style” most of the time. The once every 3-6 weeks is a good suggestion. Thanks! Philippe Bellefleur April 23, 2015 at 9:38 amLog in to Reply This is an awesome site with some of the best info out there. Keep up the excellent work. I agree with everyone, this was a great review of a great challenge. We should have these incorporated every 4-6 weeks to help us think back and put everything together Amal Mattu April 23, 2015 at 11:21 amLog in to Reply Ok, thanks so much to you all for the feedback. We’ll do these potpourris intermittently. Doug, I have a tough time managing my own finances so I’m sure if I were in charge of a business, corporation, state, or country, we’d all be bankrupt very quickly! I better just stick with emergency medicine. Rudi, in regards to junctional vs. ectopic atrial rhythm…junctional rhythms usually have either a very short PR ( 120 ms), we assume it’s coming from the atrium rather than the AV node. And since this is not a “sinus” P wave, it must be coming from another foci in the atrium, thus it’s an “ectopic atrial rhythm.” I hope that makes sense. Let me know if not. Amal Stethoscope Nunchucks April 24, 2015 at 2:12 pmLog in to Reply Thermometer? Never heard of that before. 😉 Charlene Black April 24, 2015 at 2:32 pmLog in to Reply I really enjoyed this type of review of multiple cases. I would like to do it once in a while. Thank you for all your work to provide such excellent, up to date ECG information at an affordable price! dilip April 26, 2015 at 2:00 pmLog in to Reply This is Dilip from chennai , India 🙂 and first of all i d like to tell that i m a huge fan of your work sir ! Thanks ! And intermittent multiple case reviews are great and i d like to have it once in a while, maybe once in 6 weeks ! Aldo Marano May 2, 2015 at 8:52 amLog in to Reply Dear Amal, I talk to you some times before. Now I got a new question regarding the ECG-Case in the image below. I had a similar case the last month and I was discussing with colleagues regarding the appropriate definition of this rhythm. All members of my team agreed and correctly recognized, that there it was an atrial activity at about 250/min with a 2:1 conduction pattern. Also the acute therapy was not actually difficult. But the key point was for me, that the long time management of atrial flutter and atrial tach ist totally different regarding the anticoagulation. If I call it Aflu I must evaluate the indication to OAC according the Chads-Vasc Score. If I call it Atach I don´t. How do you help yourself (and me too) when you got some ECGs with borderline atrial speed such this one? What is your threshold to call it Aflu and correspondingly plan an OAC-Therapy? Thank you really much and greets from Germany Aldo Shane74C May 13, 2015 at 4:09 amLog in to Reply Sorry for the late comment. Me too think it is great to have occasional runs of cases. Amal, just to confirm with you: did you say “propofol” is the best drug for VTachs (minute 24:35)? Also, would you go for signs like Brugada sign and Josephson sign to differentiate VTs vs SVTs with aberrancy? I do sometimes find these signs quite difficult to detect. InkaRN December 6, 2017 at 7:53 pmLog in to Reply propofol prior to cardioversion 🙂 Dr Mattu has his unique style of explaining things. Keeps us on our toes. Munieb Younus August 26, 2015 at 2:55 pmLog in to Reply Really nice InkaRN December 6, 2017 at 7:56 pmLog in to Reply Dr Mattu, it would be great to have this kind of class now and then– A fast review is very helpful! Leave A Comment Cancel replyYou must be logged in to post a comment.