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Ken Grauer, MD
AUGUST 29, 2024
MY Impression of ECG #1: As emphasized often in this ECG Blog ( See today's ADDENDUM below ) — statistical odds that a regular WCT rhythm without clear sign of sinus P waves will turn out to be VT begin at 80% likelihood. See ECG Blog #287 — if interested in more on ECG recognition of AFlutter ). How Would You Treat this Patient?
Ken Grauer, MD
JUNE 27, 2024
As discussed in ECG Blog #231 — Bidirectional VT is a special form of VT, in which there is beat-to-beat alternation of the QRS axis. See My Comment in the June 1, 2020 post in Dr. Smith's ECG Blog — for review of Pleomorphic VT. Multifocal vs Polymorphic VT — September 23, 2011 post from Dr. S.
Ken Grauer, MD
JUNE 22, 2024
And as per ECG Blog #350 — this could represent Wellens ' Syndrome IF this chest lead T wave inversion was new and occurred in a patient who initially had a normal ECG, and then had an episode of transient CP that had resolved at the time this ECG with chest lead T wave inversion was recorded.
Ken Grauer, MD
MAY 31, 2024
PEARL # 1: As I emphasize in ECG Blog #148 ( from where I took the tracing I show in Figure-3 ) — the BEST way to prove artifact — is to recognize persistence of an underlying spontaneous rhythm that is unaffected by any erratic or suspicious deflections that are seen. Figure-3: I've reproduced this tracing from ECG Blog #148 ( See text ). =
Ken Grauer, MD
AUGUST 22, 2024
As opposed to polymorphic VT that by definition is irregularly irregular — monomorphic VT is usually a fairly ( if not completely ) regular rhythm ( See ECG Blog #231 for the various forms of VT ). Regarding Q - R - S - T Changes: There is a Q wave in lead III. R wave progression is not normal.
Ken Grauer, MD
JULY 4, 2024
I favor starting with the long lead II rhythm strip — by use of the P s, Q s, 3 R Approach ( See ECG Blog #185 for more on the Ps, Qs, 3Rs ). For more on the " Footprints " of Wenckebach — See ECG Blog #164. R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation.
Ken Grauer, MD
AUGUST 8, 2024
PEARL # 3: While not 100% predictive — seeing a significant negative component to the P wave in these leads ( as per the YELLOW arrows in Figure-2 ) — suggests that the V1,V2 electrodes may be placed 1 or 2 interspaces too high on the chest ( See ECG Blog #274 — for more on too high placement of the V1,V2 electrode leads ). Smith's ECG Blog.
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