https://en.ecgpedia.org/api.php?action=feedcontributions&user=158.110.144.29&feedformat=atomECGpedia - User contributions [en]2024-03-29T08:51:07ZUser contributionsMediaWiki 1.39.5https://en.ecgpedia.org/index.php?title=Rhythm_Puzzles&diff=5374Rhythm Puzzles2007-11-04T11:47:53Z<p>158.110.144.29: </p>
<hr />
<div>acliorra<br />
These Rhythm Puzzles have been published in the '''Netherlands Heart Journal''' and are reproduced here with permission from the publisher, '''Bohn Stafleu Van Loghum'''.<br />
==2007==<br />
# [[Wide complexes intervening regular sinus rhythm - 2]]<br />
# [[Palpitations after a MAZE procedure]]<br />
# [[Abnormal repolarisation, spot diagnosis]]?<br />
# [[An irregular rhythm at older age]]<br />
# [[Palpitations all the time]]<br />
# [[Five years of palpitations]]<br />
==2006==<br />
# [[Right you are]]<br />
# [[Should I be worried?]]<br />
# [[A pre-excited wide QRS complex: is that all there is?]]<br />
# [[An old lady with chest pain]]<br />
# [[Palpitations and dizziness in a 65-year-old-man]]<br />
# [[A narrow QRS complex tachycardia sensitive to Isoptin]]<br />
# [[And what about the ECG?]]<br />
# [[Palpitations again, have a closer look]]<br />
# [[Wide complexes intervening regular sinus rhythm]]<br />
==2005==<br />
# [[ECG puzzle: Appearances can be deceiving]]<br />
# [[Where do the extras come from?]]<br />
# [['The turtle and the hare']]<br />
# [[Now you see it, now you don't]] (answer is missing)<br />
# [[It's not what you think it is]]<br />
# [[One is enough, two is too many]]<br />
# [[The ECG of a (cardio)myopathy?]]<br />
# [[The ions have it]]<br />
<br />
==2004==<br />
# [[Puzzle 2004 2 73, A fainting lady with some extrasystoles|A fainting lady with some extrasystoles]]<br />
# [[Syncopated rhythm]]<br />
# [[Rhythm Puzzle: An irregular rhythm at older age|An irregular rhythm at older age]]<br />
# [[I think a niece of mine was referred to a neurologist]]<br />
# [[Just one Collaps During Soccer]]<br />
# [[Tachycardia terminated by adenosine]]<br />
# [[Nightly phenomena, day time work?]]</div>158.110.144.29https://en.ecgpedia.org/index.php?title=Ectopic_Complexes&diff=5373Ectopic Complexes2007-11-04T11:47:28Z<p>158.110.144.29: </p>
<hr />
<div>monvartada<br />
{{authors|<br />
|mainauthor= [[user:Drj|J.S.S.G. de Jong]]<br />
|moderator= [[user:Drj|J.S.S.G. de jong]]<br />
|supervisor= <br />
}}<br />
The pacemakercells in the sinusnode are not the only cells in the heart that can depolarize spontaneously. Actually all cardiomyoctyes have this capacity. The only reason why the sinusnode 'rules' is that it is the fastest pacemaker of the heart. From sinusnode to ventricle all healthy cardiomyocytes can function as a ectopic pacemaker. Ectopic pacemaker activity can originate from the atria (60-80 bpm), AV-node (40-60 bpm) and the ventricles (20-40 bpm). So, as the sinus rate drops (e.g. during atrial infarction), other cells can take over. The configuration of ectopic beats or extrasystoles, as seen on the ECG, reveals its origin, whether they are [[#Atrial premature beats|atrial]], nodal or [[#Premature ventricular beats(PVB) / Venticular extrasystoles (VES)|ventrical]].<br />
<br />
===Ectopic pacemakers===<br />
{| class="wikitable"<br />
|+ '''Heart cells with pacemaker activity'''<br />
! Celltype || Frequency || QRS width (*)<br />
|-<br />
| ''SA node'' (not ectopic)|| 60-100 bpm || narrow<br />
|-<br />
| ''Atrial || 55-60 bpm || narrow<br />
|-<br />
| ''AV Nodal ectopic pacemaker'' || 45-50 bpm || narrow<br />
|-<br />
| ''His bundle'' || 40-45 bpm || narrow<br />
|-<br />
| ''Bundle branch'' || 40-45 bpm || narrow or wide<br />
|-<br />
| ''Purkinje cells'' || 35-40 bpm|| wide<br />
|-<br />
| ''Myocardial cells'' || 30-35 bpm|| wide<br />
|-<br />
|}<br />
(*) QRS width can only be narrow if the conduction system downstream is normal (i.e. no bundle branch block)<br />
<br />
===Examples===<br />
*[[Atrial Rhythm]]<br />
*[[Wandering Pacemaker]]<br />
*[[Atrial Premature Complexes]]<br />
*[[AV-nodal complexes]]<br />
*[[Ventricular Premature Beats]]</div>158.110.144.29https://en.ecgpedia.org/index.php?title=Technical_Problems&diff=5372Technical Problems2007-11-04T11:47:17Z<p>158.110.144.29: </p>
<hr />
<div>rolricpasv<br />
{{authors|<br />
|mainauthor= [[user:Drj|J.S.S.G. de Jong]]<br />
|moderator= [[user:Drj|J.S.S.G. de Jong]]<br />
|supervisor= <br />
}}<br />
==Lead reversals==<br />
[[Image:cableReversal1.png|thumb|Right and left arm lead reversal can be distinguished from the (much rarer) dextrocardia by looking at the p-wave.]]<br />
[[Image:cableReversal2.png|thumb|Right arm and left leg lead reversal. Lead II now measures the signal between the left and right leg, which is remote from the heart.]]<br />
Sometimes an ECG is made properly. Mistakes do happen and leads can be switched. Always remain careful to check this or you might come to the wrong conclusions. One of the most common mistakes is to switch the right and left arm. This will result in negative complexes in I, indicating a right axis deviation!<br />
<br />
Common mistakes are reversal of:<br />
*right leg and right arm:<br />
**Hardly any signal in lead II.<br />
*right and left arm electrodes; <br />
**reversal of leads II and III<br />
**reversal of leads aVR and aVL<br />
*left arm and left leg:<br />
**reversal of leads I and II<br />
**reversal of leads aVR and aVF<br />
**inversion of lead III<br />
*right arm and left leg:<br />
**inversion of leads I, II and III<br />
**reversal of leads aVR and aVF<br />
<br />
<br />
It is possible to distinguish lead reversal and [[w:Dextrocardia|dextrocardia]] by watching the precordial leads. Dextrocardia will show an R wave inversion, wheras lead reversal will not.<br />
{{clr}}<br />
<br />
==Artefacts==<br />
[[Image:Noise_move.png|thumb| Movement artefacts]]<br />
[[Image:ECG_Parkinson.png|thumb| Increasing movement artefacts in a Parkinson patient. The patient was in sinus rhythm! (which doesn't show on this short recording)]]<br />
[[Image:BaselineDrift.png|thumb| Baseline drift. The amplifier in the ECG machine has to re-find the 'mean'. This often occurs right after lead connection and after electric cardioversion.]]<br />
[[Image:cardioversion_from_afib.jpg|thumb| Cardioversion from atrial fibrillation to sinusrhythm, with clear baseline drift.]]<br />
[[Image:electric_noise_ecg.png|thumb| Electrical interference from a nearby electrical appliance. A typical example is a 100 Hz background distortion from fluorescent lights. Not to be confused with [[arrhythmias#atrial fibrillation|atrial fibrillation]].]]<br />
[[Image:electric_noise_ecg2.jpg|thumb| Another example of an artefact caused by an electrical appliance. The patients rhythm is regular. This strip shows 10 QRS complexes.]]<br />
<br />
Artefacts (disturbances) can have many causes. Common causes are:<br />
*Movement <br />
*Electrical interference<br />
<br />
{{clr}}</div>158.110.144.29