Amal Mattu’s ECG Case of the Week – April 27, 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|2016-12-21T17:14:56-04:00April 27th, 2015|8 Comments Share This Story, Choose Your Platform! FacebookTwitterLinkedInGoogle+TumblrPinterestEmail Related Posts Amal Mattu’s ECG Case of the Week – October 21, 2019 Gallery Amal Mattu’s ECG Case of the Week – October 21, 2019 Amal Mattu’s ECG Case of the Week – October 14, 2019 Gallery Amal Mattu’s ECG Case of the Week – October 14, 2019 Amal Mattu’s ECG Case of the Week – October 7, 2019 Gallery Amal Mattu’s ECG Case of the Week – October 7, 2019 Amal Mattu’s ECG Case of the Week – September 30, 2019 Gallery Amal Mattu’s ECG Case of the Week – September 30, 2019 Amal Mattu’s ECG Case of the Week – September 23, 2019 Gallery Amal Mattu’s ECG Case of the Week – September 23, 2019 8 Comments Eran Werner April 27, 2015 at 10:38 am Log in to Reply Hi Amal, I find it confusing to define a rhythm as ST, CAB, JER 40. I believe the term tachycardia, and sinus rhythm should be left to rhythms that eventually produce ventricular contractions, and have an origin at the sinus. Don’t you think the P wave activity is eventually of secondary importance as it has in this case no effect on the cardiac output, i.e. wouldn’t you prefer a medic to call out this rhythm as “I have a patient with severe Bradycardia. He has a complete AVB with 40 BPM, oh and also his sinus is going fast…. ” 🙂 Amal Mattu April 27, 2015 at 2:58 pm Log in to Reply Eran, As you are suggesting, what the ventricle is doing is the key, and if you are giving a quick report then you should indicate the key finding(s). But in terms of providing a full interpretation for teaching purposes, I want people to understand what the atrium is doing and also what the ventricle is doing, so I talk about both. Also, if you were to look at a cardiologist’s full interpretation that is used for their boards or for final interps in a medical record, they would indicate the full thing. However, I’m clearly prone to shortcuts also…in the second case, since this week I was focusing on rhythms, I only talked about the Mobitz I and didn’t bother to provide the full interpretation which would have mentioned that there’s also a STEMI. Hopefully in the real world nobody would have missed that slight detail! Amal Victoria Alice Westwood April 27, 2015 at 6:03 pm Log in to Reply Thanks so much Dr Mattu for putting this case up. I diagnosed a complete heart block last week in an elderly man with a ventricular rate of 40. The ECG was quite hard to interpret because the p waves were of a very low voltage and there were ventricular ectopic beats. I checked the patient was stable (which he was) and took the ECG to the medical registrar to make him aware of the diagnosis. He was obviously not a cardiologist because he told me it couldn’t possibly be CHB because the QRS complexes were narrow! I was a bit After a bit more reading and watching your video today however I will have the confidence to argue my point next time. I went to see the patient the next day and out of all the doctors to see him only the senior cardiologist had diagnosed 3rd degree heart block and he was sent for a pacemaker. I feel like I’m making real progress with these tutorials of yours so many thanks. michael halberg April 27, 2015 at 10:08 pm Log in to Reply Great episode again. In some of these it is tough for me to say which is the p and which is the t. Sometimes the first bump after the qrs is the p and sometimes vise versa. Do you just guess based on the appearance and then see if it maps out? Nate Zas April 27, 2015 at 10:58 pm Log in to Reply Nice cases and good practice. I love the polyuria pun! Michael Mitchell April 28, 2015 at 2:58 am Log in to Reply So clear and well presented. Poor old Wenkebach RIP, he got renamed to Mobitz 1. Amal Mattu April 28, 2015 at 1:19 pm Log in to Reply Michael M, Now I feel bad for not saying Wenkebach. But I have a tough time remembering how to spell it. Also, it’s not fair that Mobitz II doesn’t have a special name! Michael H, it is tough sometimes to know if there’s a P buried in a T. Look for an abnormal morphology of the T (usually it has a pointy appearance or a camel-hump appearance if there’s a buried P) and also see if it maps out. If it maps out with the Ps, I really lean towards assuming there’s a buried P. Ts shouldn’t map out with Ps…it’s too much coincidence. Victoria, that’s awesome! Keep up the great work and thanks so much for the feedback! AM Nathan Marcy May 11, 2015 at 1:48 pm Log in to Reply Dr. Mattu: What’s the technical differential between AV Disassociation and 3°AVB/CHB? Leave A Comment Cancel replyYou must be logged in to post a comment.