Case reports from Michael Rosengarten: Difference between revisions
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*[[McGill Case 2|A 70 year old woman with recurrent ventricular tachycardia and a severe intra-ventricular conduction defect.]] | *[[McGill Case 2|A 70 year old woman with recurrent ventricular tachycardia and a severe intra-ventricular conduction defect.]] | ||
*[[McGill Case 3|A 62 year old man with a severe intra-ventricular conduction defect simulating ventricular bigemini.]] | *[[McGill Case 3|A 62 year old man with a severe intra-ventricular conduction defect simulating ventricular bigemini.]] | ||
===Right Bundle Branch Block=== | ===Right Bundle Branch Block=== | ||
*[[McGill Case 4|An elderly man with RBBB and possible LPHB.]] | |||
*[[McGill Case 5|An elderly man with RBBB and atrial flutter.]] | |||
*[[McGill Case 6|A patient with PACs conducted with a RBBB.]] | |||
*[[McGill Case 7|A patient with a RBBB and PACs.]] | |||
*[[McGill Case 8|A patient with a RBBB secondary to massive Pulmonary embolism.]] | |||
*[[McGill Case 9|A 35 yr. old patient with possible Chagas disease induced right bundle branch block.]] | |||
===Left Bundle Branch Block=== | |||
*[[McGill Case 10|Recordings of rate dependent left bundle branch block.]] | |||
*[[McGill Case 11|Case two.]] | |||
*[[McGill Case 12|Left bundle branch block and first degree A/V block.]] | |||
===Left Anterior Fasicular Block=== | |||
*[[McGill Case 13|Case one (in the setting of an acute anterior wall MI)]] | |||
*[[McGill Case 14|in a middle aged man with first degree block.]] | |||
*[[McGill Case 15|an 80 year old man.]] | |||
*[[McGill Case 16|A 77 year old man with previous myocardial infarction.]] | |||
===Left Posterior Fasicular Block=== | |||
*[[McGill Case 17|A 19 year old boy with an normal echocardiogram.]] | |||
===Bifasicular block=== | |||
====Right bundle branch block with left anterior hemi-block==== | |||
*[[McGill Case 18|In a 41 year old patient who had had surgical correction of Tetalogy of Fallot.]] | |||
*[[McGill Case 19|With possible RVH.]] | |||
*[[McGill Case 20|In a patient with atrial fibrillation.]] | |||
*[[McGill Case 21|In a elderly man with possible left atrial abnormality.]] | |||
*[[McGill Case 22|54 year old man with a heart transplant.]] | |||
====Right bundle branch block with left posterior hemi-block==== | |||
*[[McGill Case 23|A patient on the hospital ward with RBBB, Left Posterior Hemiblock, criteria for LAA and RAA.]] | |||
*[[McGill Case 24|An elderly woman with a history of ventricular tachycardia]] | |||
===Alternating Bundle Branch Block=== | |||
*[[McGill Case 25|Case one]] | |||
===Trifasicular block=== | |||
*[[McGill Case 26|Case one]] | |||
*[[McGill Case 27|Case two]] | |||
*[[McGill Case 28|Case three]] | |||
====A/V Blocks==== | |||
===First degree block:=== | |||
*[[McGill Case 29|A 77 year old man with previous myocardial infarction.]] | |||
*[[McGill Case 30|A 63 year old man]] | |||
*[[McGill Case 31|second case]] | |||
*[[McGill Case 32|third case]] | |||
*[[McGill Case 33|In a middle aged man with LAFB]] | |||
*[[McGill Case 34|In a 20 year old woman with Ebstien's anomaly]] | |||
*[[McGill Case 35|In an 87 year old man with a VVI pacemaker]] | |||
===Second degree block=== | |||
====Mobitz I==== | |||
*[[McGill Case 36|Mobitz I A/V block and high grade A/V block from a woman with pre-syncope.]] | |||
====Mobitz II==== | |||
*[[McGill Case 37|A patient with MobitzII A/V block post pacemaker implant for syncope]] | |||
*[[McGill Case 38|From a Holter recording from a middle aged woman, also shows 2:1 block]] | |||
====Complete heart block==== | |||
*[[McGill Case 39|Complete heart block detected with a Reveal implantable monitor.]] | |||
*[[McGill Case 40|A 65 year old woman with tiredness and difficulty walking. The EKG shows complete heart block.]] | |||
*[[McGill Case 41|An 85 year old patient with previous trifasicular block]] | |||
===Sinus Node Block:=== | |||
*[[McGill Case 42|A middle aged woman treated for atrial fibrillation with a possible sinus node exit block (Mobitz 1)]] | |||
==Arrhythmias== | ==Arrhythmias== | ||
===Supraventricular Arrhythmias=== | ===Supraventricular Arrhythmias=== | ||
*[[McGill Case 1|A 64 year old woman with atrial fibrillation and left ventricular | ====Sinus pauses==== | ||
*[[McGill Case 43|From a Holter monitor]] | |||
*[[McGill Case 44|On termination of atrial fibrillation]] | |||
====Premature atrial complexes==== | |||
*[[McGill Case 45|Case one]] | |||
*[[McGill Case 46|Case two]] | |||
*[[McGill Case 47|PACs in trigemini]] | |||
====Atrial fibrillation==== | |||
*[[McGill Case 48|Atrial fibrillation in a patient with a RBBB and LAHB]] | |||
*[[McGill Case 49|Atrial fibrillation in an elderly man]] | |||
*[[McGill Case 50|A 64 year old woman with atrial fibrillation and left ventricular hypertrophy]] | |||
*[[McGill Case 51|A 84 year old woman]] | |||
*[[McGill Case 52|Case three with a first EKG showing left atrial abnormality and a second with atrial fibrillation]] | |||
====Supraventricular Tachycardia==== | |||
=====Without block===== | |||
*[[McGill Case 53|A 70 year old man with supraventricular tachycardia for years]] | |||
=====With block===== | |||
*[[McGill Case 54|Supraventricular tachycardia with block in a woman in her fifties.]] | |||
*[[McGill Case 55|A 72 year old man with supraventricular tachycardia with block or slow atrial flutter.]] | |||
*[[McGill Case 56|Supraventricular tachycardia/flutter with increased ventricular response after IV diltiazem.]] | |||
*[[McGill Case 57|A tracing from an 80 year old man post aortic valve replacement.]] | |||
*[[McGill Case 58|A 12 lead EKG from a 72 year old man with supraventricular tachycardia with 2:1 block.]] | |||
*[[McGill Case 59|An elederly woman with a mitral valve replacement.]] | |||
====Atrial Flutter==== | |||
*[[McGill Case 60|Atrial flutter with 4:1 block and RBBB.]] | |||
*[[McGill Case 61|Supraventricular tachycardia/flutter with increased ventricular response after IV diltiazem.]] | |||
*[[McGill Case 62|A wide complex tachycardia (atrial flutter with 1:1 conduction) in a patient with corrected Tetralogy of Fallot. Recorded with a loop monitor.]] | |||
*[[McGill Case 63|A case of tachy-brady syndrome. The recording is from a loop recorder and shows atrial flutter followed by asystole.]] | |||
*[[McGill Case 64|A patient in the hospital with atrial flutter and a slow ventricular response.]] | |||
*[[McGill Case 65|A 65 year old man']] | |||
*[[McGill Case 66|A man in his 50's before and after adenosine.]] | |||
====Nodal Rhythm:==== | |||
*[[McGill Case 67|Three ECGs (0ne of which is nodal rhythm ) and X-ray from a patient with syncope and chest pain.]] | |||
=====Accelerated nodal rhythm===== | |||
*[[McGill Case 68|Nodal rhythm in a woman in her fifties.]] | |||
*[[McGill Case 69|Accellerated nodal rhythm in a woman in her seventies.]] | |||
====Wolf Parkinson White==== | |||
*[[McGill Case 70|WPW in a 55 year old woman]] | |||
*[[McGill Case 71|WPW in a 43 year old man]] | |||
*[[McGill Case 72|Case three]] | |||
*[[McGill Case 73|Case four]] | |||
*[[McGill Case 74|Case five]] | |||
*[[McGill Case 75|Case six]] | |||
====Other atrial rhythms==== | |||
*[[McGill Case 76|54 year old man with a heart transplant.]] | |||
===Ventricular Arrhythmias=== | |||
====Premature Complexes==== | |||
*[[McGill Case 77|In an 87 year old man.]] | |||
=====Bigemini===== | |||
*[[McGill Case 78|PVCs in bigemini in a 75 year old woman.]] | |||
*[[McGill Case 79|PVCs in bigemini in a 75 year old woman #2]] | |||
*[[McGill Case 80|Bigemini in a 60 year old man]] | |||
*[[McGill Case 81|Interpolated PVCs in a 80 year old woman.]] | |||
*[[McGill Case 82|A patient on the hospital ward with PVCs as well as RBBB, Left Posterior Hemiblock, criteria for LAA and RAA.]] | |||
*[[McGill Case 83|PVC couplets.]] | |||
*[[McGill Case 84|PVC salvos]] | |||
====Ventricular Tachycardia==== | |||
*[[McGill Case 85|Two EKG strips from a patient with a failing pacemaker and Torsade de Pointes ventricular tachycardia ]] | |||
*[[McGill Case 86|An EKG from a patient in the surgical recovery room showing Torsade de Pointes ventricular tachycardia]] | |||
*[[McGill Case 87|From an elderly woman]] | |||
*[[McGill Case 88|Ventricular tachycardia an elderly woman]] | |||
*[[McGill Case 89|Two ECGs from a patient in an emergency room, first with ventricular tachycardia and then after a shock, sinus rhythm.]] | |||
*[[McGill Case 90|A 66 year old man with fast ventricular tachycardia]] | |||
*[[McGill Case 91|A 35 year old man with an acute inferior wall M.I. and ventricular tachycardia.]] | |||
*[[McGill Case 92|12 lead recording of ventricular tachycardia with intracardiac recordings in a patient with a dual chamber pacer/defibrillator and a severe intra-ventricular conduction defect.]] | |||
*[[McGill Case 93|VT in 62 year old man with a previous inferior wall myocardial infarction and a history of ventricular tachycardia. This page shows his EKG and an abnormal surface average EKG.]] | |||
====Ventricular Fibrillation==== | |||
*[[McGill Case 94|12 lead recordings from two patients with ventricular fibrillation]] | |||
*[[McGill Case 95|Ventricular capture beats with paced ventricular rhythm]] | |||
*[[McGill Case 96|A patient with recurrent wide complex tachycardia]] | |||
*[[McGill Case 97|A 70 year old woman with recurrent ventricular tachycardia and a severe intra-ventricular conduction defect.]] | |||
==Implanted Devices== | |||
===Cardiac Pacemakers=== | |||
====Examples of different pacing modes==== | |||
=====DDD pacemakers===== | |||
*[[McGill Case 98|DDD timing diagram in sinus rhythm with an AV delay of 80ms.]] | |||
*[[McGill Case 99|DDD mode showing atrial and ventricular pacing and atrial sensing and venticular pacing.]] | |||
*[[McGill Case 100|DDD mode showing ventricular tracking of atrial fibrillation]] | |||
*[[McGill Case 101|DDI timing diagram in sinus rhythm and with one PVC with an AV delay of 80ms.]] | |||
*[[McGill Case 102|DDI pacing at a lower rate of 50/min ]] | |||
*[[McGill Case 103|DDD pacemaker recorded on a 12 lead EKG. Patient has a severe intraventricular conduction abnormality]] | |||
*[[McGill Case 104|DDD pacemaker at its upper rate limit in a patient with atrial fibrillation/flutter]] | |||
*[[McGill Case 105|DDD pacemaker failing to sense a P wave]] | |||
*[[McGill Case 106|DDD pacemaker the effect of a PVC on the timing cycles ]] | |||
*[[McGill Case 107|DDD pacemaker timing diagram with atrial lead pacing the ventricle]] | |||
*[[McGill Case 108|A patient with atrial tachycardia with an intra-atrial recording from his pacemaker ]] | |||
*[[McGill Case 109|Ladder diagrams and tracings while in DDI mode and complete heart block.]] | |||
*[[McGill Case 110|DDD pacer set at 70/min. but atrial pacing at 75/min due to conduction with a PR interval shorter than the A/V interval set on the pacemaker.]] | |||
*[[McGill Case 111|Recording from the atrial lead of a patient with atrial fibrillation]] | |||
=====Atrial pacing===== | |||
*[[McGill Case 112|AAI with ladder diagram]] | |||
*[[McGill Case 113|AAI pacing 12 lead with a patient with Right Ventricular dysplasia taking Flecainide for ventricular tachycardia.]] | |||
*[[McGill Case 114|A series of electrocardiograms from a 78 year old woman who was implanted with a VVI pacemaker in 1991. The patient developed congestive heart failure five years later due to pacemaker syndrome which was corrected by switching to atrial pacing.]] | |||
*[[McGill Case 115|A patient with an atrial pacer that did not seem to pace properly.]] | |||
*[[McGill Case 116|Two rhythm strips from a patient with an AAI.R pacemaker with atrial sensing of the QRS due to a prolonged PR interval.]] | |||
*[[McGill Case 117|12 lead electrocardiogram of a patient with right ventricular dysplasia and paced rhythm]] | |||
*[[McGill Case 118|A rhythm strip from a patient that shows AAI pacing competing with and resetting the patient's nodal rhythm.]] | |||
*[[McGill Case 119|Atrial pacing with competition from an accelerated ventricular rhythm causing fusion complexes]] | |||
*[[McGill Case 120|An irregular rhythm with an atrial pacemaker.]] | |||
=====Ventricular Pacing===== | |||
*[[McGill Case 121|VVI with ladder diagram]] | |||
*[[McGill Case 122|Ventricular paced rhythm with atrial flutter]] | |||
*[[McGill Case 123|VVI pacing in patient with first degree A/V block]] | |||
*[[McGill Case 124|Ventricular paced rhythm with atrial flutter after A/V nodal ablation.]] | |||
*[[McGill Case 125|The effect of an acute myocardial infarction on the EKG of VVI pacing]] | |||
*[[McGill Case 126|Failure to pace or a recording artifact? This is a recording from a patient with a Medtronic implantable defibrillator which also functions as a VVI pacemaker.]] | |||
*[[McGill Case 127|Lead failure in a recently replaced VVI pacemaker.]] | |||
*[[McGill Case 128|Escape/capture bigemini]] | |||
*[[McGill Case 129|A rate responsive pacemaker with a respiratory sensor]] | |||
*[[McGill Case 130|A recording showing rate hysteresis]] | |||
*[[McGill Case 131|Pacing during ventricular fibrillation and failure to capture after a 360 joule shock.]] | |||
====Pacing conduction patterns==== | |||
*[[McGill Case 132|A 12 lead electrocardiogram from a patient with a lead pacing the left ventricle.]] | |||
*[[McGill Case 133|Tracings from a the same patient with right atrial appendage stimulation, R.V. septal and apical stimulation.]] | |||
*[[McGill Case 134|A tracing from a patient with Mobitz I AV block where the AV conduction stops with VDD pacing even with a long sensed to paced interval of 300ms.]] | |||
====Pacemaker interactions==== | |||
*[[McGill Case 135|A patient with two pacemakers, a DDD and a VVI .R which is at end of life]] | |||
*[[McGill Case 136|Myopotential inhibition of a VVI.R pacemaker]] | |||
*[[McGill Case 137|Suppression of a VVI pacemaker with an external pacemaker]] | |||
====Pacemaker Pacing Artifacts==== | |||
*[[McGill Case 138|Bipolar ventricular paced rhythm with atrial flutter after A/V nodal ablation.]] | |||
*[[McGill Case 139|Unipolar ventricular paced rhythm with atrial flutter]] | |||
====Pacemaker Follow-up==== | |||
=====Unusual rhythms===== | |||
*[[McGill Case 140|Bigemini with magnet over the pacemaker]] | |||
*[[McGill Case 141|Bigemini with atrial threshold testing]] | |||
*[[McGill Case 142|Conversion of atrial flutter with rapid atrial pacing followed by nodal rhythm ]] | |||
=====Threshold Testing===== | |||
*[[McGill Case 143|3 lead rhythm strip with DDD pacemaker and normal magnet response]] | |||
*[[McGill Case 144|Pulse amplitude threshold testing for a ventricular pacemaker]] | |||
======Atrial threshold testing====== | |||
*[[McGill Case 145|Atrial threshold testing in a DDD pacer using the AAI mode]] | |||
*[[McGill Case 146|Atrial threshold testing in a model 2102 pacemaker]] | |||
*[[McGill Case 147|PVCs interfering with ventricular threshold testing]] | |||
*[[McGill Case 148|The effect of a long AV interval on atrial threshold testing of a DDD Pacer]] | |||
*[[McGill Case 149|Threshold testing inducing asystole in a 21 year old patient with congenital complete heart block.]] | |||
*[[McGill Case 150|Two pacemakers, DDD and VVI with atrial capture in one and ventricular in the other]] | |||
=====Strength duration curves===== | |||
*[[McGill Case 151|A strength/duration curve from an atrial lead.]] | |||
*[[McGill Case 152|A strength/duration curve from a ventricular lead.]] | |||
=====Time dependent capture===== | |||
*[[McGill Case 153|Example one (ventricular)]] | |||
*[[McGill Case 154|Example two (ventricular)]] | |||
*[[McGill Case 155|Example three (ventricular)]] | |||
*[[McGill Case 156|Example four (ventricular)]] | |||
*[[McGill Case 157|Example five (dual chamber pacer)]] | |||
*[[McGill Case 158|Example six (dual chamber pacer)]] | |||
=====Pacemaker system failure===== | |||
*[[McGill Case 159|Pacemaker pacing failure and Mobitz II A/V block in a patient with a history of Torsade de Pointe and three degree heart block.]] | |||
*[[McGill Case 160|A patient with a failing ventricular lead due to a subclavian crush.]] | |||
=====Trans-telephonic EKG recordings===== | |||
*[[McGill Case 161|Trans-telephonic pacemaker check failure to capture]] | |||
*[[McGill Case 162|Trans-telephonic pacemaker check: Failure to capture. A patient in the high Arctic.]] | |||
*[[McGill Case 163|Trans-telephonic pacemaker check at the MUHC (instructions)]] | |||
=====Trans-telephonic Audio recordings===== | |||
*[[McGill Case 164|The EKG and sound of a Medtronic VVI.P pacemaker with the magnet applied near the end of the recording]] | |||
*[[McGill Case 165|Recording of end of life indication with magnet applied to VVI pacemaker]] | |||
*[[McGill Case 166|A pacemaker that required inversion of the programming head for programming. The pacemaker could not be programmed in the usual manner in the pacemaker clinic. The pacemaker was implanted correctly with the conducting window toward the skin, but was a left-sided model which differed from the previous x-ray outline of the right-sided model. Having to invert the programming head suggests a problem with the programming head, inverted implantation of the pacemaker, or because the pacemaker electronics are functioning as a contra-lateral pacemaker.]] | |||
===Defibrillation and Cardioversion=== | |||
=====External Cardioversion/defibrillation===== | |||
*[[McGill Case 167|Recording of a series of shocks for Atrial Flutter]] | |||
*[[McGill Case 168|Sinus pause post cardioversion for atrial fibrillation ]] | |||
*[[McGill Case 169|An irregular rhythm after cardioversion for atrial fibrillation]] | |||
*[[McGill Case 170|pacing during ventricular fibrillation caused by cardioversion and failure to capture after a 360 joule shock.]] | |||
=====Implantable Defibrillators===== | |||
*[[McGill Case 171|Recording from a device during a spontaneous episode of ventricular fibrillation.]] | |||
*[[McGill Case 172|P.A. chest film of a patient with an implantable defibrillator and an epicardial patch and S.V.C. spring electrode.]] | |||
======Threshold Testing====== | |||
*[[McGill Case 173|Defibrillation threshold testing of an implantable defibrillator (successful) followed by ventricular paced rhythm.]] | |||
*[[McGill Case 174|Defibrillation threshold testing of an implantable defibrillator (successful) followed by sinus rhythm.]] | |||
*[[McGill Case 175|Defibrillation threshold testing of an implantable defibrillator (successful) followed by sinus rhythm. Recorded using an external defibrillator.]] | |||
===ECG Recordings=== | |||
*[[McGill Case 176|An electrocardiogram from a patient with a cardiac myoplasty stimulator.]] | |||
*[[McGill Case 177|A problem with atrial capture with a dual chamber pacemaker with a long A/V interval.]] | |||
*[[McGill Case 178|A patient post pacemaker implant. for syncope]] | |||
*[[McGill Case 179|A rate responsive pacemaker with respiratory sensor An ECG strip from the pacemaker clinic.]] | |||
*[[McGill Case 180|A patient post DDD pacemaker implant ECG strip and images from a patient post DDD pacemaker implant.]] | |||
*[[McGill Case 181|Patient with perforation of a temporary transvenous pacemaker Three EKGs and X-ray.]] | |||
==The Normal ECG== | |||
*[[McGill Case 182|Case One]] | |||
*[[McGill Case 183|Case Two]] | |||
*[[McGill Case 184|Case Three]] | |||
*[[McGill Case 185|Case Four]] | |||
*[[McGill Case 186|Case Five]] | |||
*[[McGill Case 187|Case Six]] | |||
*[[McGill Case 188|Case Seven]] | |||
*[[McGill Case 189|Case Eight]] | |||
*[[McGill Case 190|Case Nine]] | |||
==Super Puzzler== | |||
*[[McGill Case 191|1]] | |||
*[[McGill Case 192|2]] | |||
*[[McGill Case 193|3]] | |||
*[[McGill Case 194|4]] | |||
*[[McGill Case 195|5]] | |||
*[[McGill Case 196|6]] | |||
*[[McGill Case 197|7]] | |||
*[[McGill Case 198|8]] | |||
*[[McGill Case 199|9]] | |||
*[[McGill Case 200|10]] | |||
*[[McGill Case 201|11]] | |||
*[[McGill Case 202|12]] | |||
*[[McGill Case 203|13]] | |||
*[[McGill Case 204|14]] | |||
*[[McGill Case 205|15]] | |||
*[[McGill Case 206|16]] | |||
*[[McGill Case 207|17]] | |||
*[[McGill Case 208|18]] | |||
*[[McGill Case 209|19]] | |||
*[[McGill Case 210|20]] | |||
*[[McGill Case 211|21]] | |||
*[[McGill Case 212|22]] | |||
*[[McGill Case 213|23]] | |||
*[[McGill Case 214|24]] | |||
*[[McGill Case 215|25]] | |||
*[[McGill Case 216|26]] | |||
*[[McGill Case 217|27]] | |||
*[[McGill Case 218|28]] | |||
*[[McGill Case 219|29]] | |||
*[[McGill Case 220|30]] | |||
*[[McGill Case 221|31]] | |||
*[[McGill Case 222|32]] | |||
*[[McGill Case 223|33]] | |||
*[[McGill Case 224|34]] | |||
*[[McGill Case 225|35]] | |||
*[[McGill Case 226|36]] | |||
*[[McGill Case 227|37]] | |||
*[[McGill Case 228|38]] | |||
*[[McGill Case 229|39]] | |||
*[[McGill Case 230|40]] | |||
*[[McGill Case 231|41]] | |||
*[[McGill Case 232|42]] | |||
*[[McGill Case 233|43]] | |||
*[[McGill Case 234|44]] | |||
*[[McGill Case 235|45]] | |||
*[[McGill Case 236|46]] | |||
*[[McGill Case 237|47]] | |||
*[[McGill Case 238|48]] | |||
*[[McGill Case 239|49]] | |||
*[[McGill Case 240|50]] | |||
*[[McGill Case 241|51]] | |||
*[[McGill Case 242|52]] | |||
*[[McGill Case 243|53]] | |||
*[[McGill Case 244|54]] | |||
*[[McGill Case 245|55]] | |||
*[[McGill Case 246|56]] | |||
*[[McGill Case 247|57]] | |||
*[[McGill Case 248|58]] | |||
*[[McGill Case 249|59]] | |||
*[[McGill Case 250|60]] | |||
*[[McGill Case 251|61]] | |||
*[[McGill Case 252|62]] | |||
*[[McGill Case 253|63]] | |||
*[[McGill Case 254|64]] | |||
*[[McGill Case 255|65]] | |||
*[[McGill Case 256|66]] | |||
*[[McGill Case 257|67]] | |||
*[[McGill Case 258|68]] | |||
*[[McGill Case 259|69]] | |||
*[[McGill Case 260|70]] | |||
*[[McGill Case 261|71]] | |||
*[[McGill Case 262|72]] | |||
*[[McGill Case 263|73]] | |||
*[[McGill Case 264|74]] | |||
*[[McGill Case 265|75]] | |||
*[[McGill Case 266|76]] | |||
*[[McGill Case 267|77]] | |||
*[[McGill Case 268|78]] | |||
*[[McGill Case 269|79]] | |||
*[[McGill Case 270|80]] | |||
*[[McGill Case 271|81]] | |||
*[[McGill Case 272|82]] | |||
*[[McGill Case 273|83]] | |||
*[[McGill Case 274|84]] | |||
*[[McGill Case 275|85]] | |||
*[[McGill Case 276|86]] | |||
*[[McGill Case 277|87]] | |||
*[[McGill Case 278|88]] | |||
*[[McGill Case 279|89]] | |||
*[[McGill Case 280|90]] | |||
*[[McGill Case 281|91]] | |||
*[[McGill Case 282|92]] | |||
*[[McGill Case 283|93]] | |||
*[[McGill Case 284|94]] | |||
*[[McGill Case 285|95]] | |||
*[[McGill Case 286|96]] | |||
*[[McGill Case 287|97]] | |||
*[[McGill Case 288|98]] | |||
*[[McGill Case 289|99]] | |||
*[[McGill Case 290|100]] | |||
*[[McGill Case 291|101]] | |||
*[[McGill Case 292|102]] | |||
*[[McGill Case 293|103]] | |||
*[[McGill Case 294|104]] | |||
*[[McGill Case 295|105]] | |||
*[[McGill Case 296|106]] | |||
*[[McGill Case 297|107]] | |||
*[[McGill Case 298|108]] | |||
*[[McGill Case 299|109]] | |||
*[[McGill Case 300|110]] | |||
*[[McGill Case 301|111]] | |||
*[[McGill Case 302|112]] | |||
*[[McGill Case 303|113]] | |||
*[[McGill Case 304|114]] | |||
*[[McGill Case 305|115]] | |||
*[[McGill Case 306|116]] | |||
*[[McGill Case 307|117]] | |||
*[[McGill Case 308|118]] | |||
*[[McGill Case 309|119]] | |||
*[[McGill Case 310|120]] | |||
*[[McGill Case 311|121]] | |||
*[[McGill Case 312|122]] | |||
*[[McGill Case 313|123]] | |||
*[[McGill Case 314|124]] | |||
*[[McGill Case 315|125]] | |||
*[[McGill Case 316|126]] | |||
*[[McGill Case 317|127]] | |||
*[[McGill Case 318|128]] | |||
*[[McGill Case 319|129]] | |||
*[[McGill Case 320|130]] | |||
*[[McGill Case 321|131]] | |||
*[[McGill Case 322|132]] | |||
*[[McGill Case 323|133]] | |||
*[[McGill Case 324|134]] | |||
*[[McGill Case 325|135]] | |||
*[[McGill Case 326|136]] | |||
*[[McGill Case 327|137]] | |||
*[[McGill Case 328|138]] | |||
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*[[McGill Case 344|154]] | |||
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*[[McGill Case 352|162]] | |||
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*[[McGill Case 367|177]] | |||
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*[[McGill Case 390|200]] | |||
*[[McGill Case 391|201]] | |||
*[[McGill Case 392|202]] | |||
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*[[McGill Case 394|204]] | |||
*[[McGill Case 395|205]] | |||
*[[McGill Case 396|206]] | |||
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*[[McGill Case 399|209]] | |||
*[[McGill Case 400|210]] | |||
*[[McGill Case 401|211]] | |||
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*[[McGill Case 404|214]] | |||
*[[McGill Case 405|215]] |
Latest revision as of 23:30, 19 February 2012
This case report is kindly provided by Michael Rosengarten from McGill and is part of the McGill Cases. These cases come from the McGill EKG World Encyclopedia.
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Conduction Abnormalities
Intraventricular conduction defect
- A 70 year old woman with recurrent ventricular tachycardia and a severe intra-ventricular conduction defect.
- A 62 year old man with a severe intra-ventricular conduction defect simulating ventricular bigemini.
Right Bundle Branch Block
- An elderly man with RBBB and possible LPHB.
- An elderly man with RBBB and atrial flutter.
- A patient with PACs conducted with a RBBB.
- A patient with a RBBB and PACs.
- A patient with a RBBB secondary to massive Pulmonary embolism.
- A 35 yr. old patient with possible Chagas disease induced right bundle branch block.
Left Bundle Branch Block
- Recordings of rate dependent left bundle branch block.
- Case two.
- Left bundle branch block and first degree A/V block.
Left Anterior Fasicular Block
- Case one (in the setting of an acute anterior wall MI)
- in a middle aged man with first degree block.
- an 80 year old man.
- A 77 year old man with previous myocardial infarction.
Left Posterior Fasicular Block
Bifasicular block
Right bundle branch block with left anterior hemi-block
- In a 41 year old patient who had had surgical correction of Tetalogy of Fallot.
- With possible RVH.
- In a patient with atrial fibrillation.
- In a elderly man with possible left atrial abnormality.
- 54 year old man with a heart transplant.
Right bundle branch block with left posterior hemi-block
- A patient on the hospital ward with RBBB, Left Posterior Hemiblock, criteria for LAA and RAA.
- An elderly woman with a history of ventricular tachycardia
Alternating Bundle Branch Block
Trifasicular block
A/V Blocks
First degree block:
- A 77 year old man with previous myocardial infarction.
- A 63 year old man
- second case
- third case
- In a middle aged man with LAFB
- In a 20 year old woman with Ebstien's anomaly
- In an 87 year old man with a VVI pacemaker
Second degree block
Mobitz I
Mobitz II
- A patient with MobitzII A/V block post pacemaker implant for syncope
- From a Holter recording from a middle aged woman, also shows 2:1 block
Complete heart block
- Complete heart block detected with a Reveal implantable monitor.
- A 65 year old woman with tiredness and difficulty walking. The EKG shows complete heart block.
- An 85 year old patient with previous trifasicular block
Sinus Node Block:
- A middle aged woman treated for atrial fibrillation with a possible sinus node exit block (Mobitz 1)
Arrhythmias
Supraventricular Arrhythmias
Sinus pauses
Premature atrial complexes
Atrial fibrillation
- Atrial fibrillation in a patient with a RBBB and LAHB
- Atrial fibrillation in an elderly man
- A 64 year old woman with atrial fibrillation and left ventricular hypertrophy
- A 84 year old woman
- Case three with a first EKG showing left atrial abnormality and a second with atrial fibrillation
Supraventricular Tachycardia
Without block
With block
- Supraventricular tachycardia with block in a woman in her fifties.
- A 72 year old man with supraventricular tachycardia with block or slow atrial flutter.
- Supraventricular tachycardia/flutter with increased ventricular response after IV diltiazem.
- A tracing from an 80 year old man post aortic valve replacement.
- A 12 lead EKG from a 72 year old man with supraventricular tachycardia with 2:1 block.
- An elederly woman with a mitral valve replacement.
Atrial Flutter
- Atrial flutter with 4:1 block and RBBB.
- Supraventricular tachycardia/flutter with increased ventricular response after IV diltiazem.
- A wide complex tachycardia (atrial flutter with 1:1 conduction) in a patient with corrected Tetralogy of Fallot. Recorded with a loop monitor.
- A case of tachy-brady syndrome. The recording is from a loop recorder and shows atrial flutter followed by asystole.
- A patient in the hospital with atrial flutter and a slow ventricular response.
- A 65 year old man'
- A man in his 50's before and after adenosine.
Nodal Rhythm:
Accelerated nodal rhythm
Wolf Parkinson White
Other atrial rhythms
Ventricular Arrhythmias
Premature Complexes
Bigemini
- PVCs in bigemini in a 75 year old woman.
- PVCs in bigemini in a 75 year old woman #2
- Bigemini in a 60 year old man
- Interpolated PVCs in a 80 year old woman.
- A patient on the hospital ward with PVCs as well as RBBB, Left Posterior Hemiblock, criteria for LAA and RAA.
- PVC couplets.
- PVC salvos
Ventricular Tachycardia
- Two EKG strips from a patient with a failing pacemaker and Torsade de Pointes ventricular tachycardia
- An EKG from a patient in the surgical recovery room showing Torsade de Pointes ventricular tachycardia
- From an elderly woman
- Ventricular tachycardia an elderly woman
- Two ECGs from a patient in an emergency room, first with ventricular tachycardia and then after a shock, sinus rhythm.
- A 66 year old man with fast ventricular tachycardia
- A 35 year old man with an acute inferior wall M.I. and ventricular tachycardia.
- 12 lead recording of ventricular tachycardia with intracardiac recordings in a patient with a dual chamber pacer/defibrillator and a severe intra-ventricular conduction defect.
- VT in 62 year old man with a previous inferior wall myocardial infarction and a history of ventricular tachycardia. This page shows his EKG and an abnormal surface average EKG.
Ventricular Fibrillation
- 12 lead recordings from two patients with ventricular fibrillation
- Ventricular capture beats with paced ventricular rhythm
- A patient with recurrent wide complex tachycardia
- A 70 year old woman with recurrent ventricular tachycardia and a severe intra-ventricular conduction defect.
Implanted Devices
Cardiac Pacemakers
Examples of different pacing modes
DDD pacemakers
- DDD timing diagram in sinus rhythm with an AV delay of 80ms.
- DDD mode showing atrial and ventricular pacing and atrial sensing and venticular pacing.
- DDD mode showing ventricular tracking of atrial fibrillation
- DDI timing diagram in sinus rhythm and with one PVC with an AV delay of 80ms.
- DDI pacing at a lower rate of 50/min
- DDD pacemaker recorded on a 12 lead EKG. Patient has a severe intraventricular conduction abnormality
- DDD pacemaker at its upper rate limit in a patient with atrial fibrillation/flutter
- DDD pacemaker failing to sense a P wave
- DDD pacemaker the effect of a PVC on the timing cycles
- DDD pacemaker timing diagram with atrial lead pacing the ventricle
- A patient with atrial tachycardia with an intra-atrial recording from his pacemaker
- Ladder diagrams and tracings while in DDI mode and complete heart block.
- DDD pacer set at 70/min. but atrial pacing at 75/min due to conduction with a PR interval shorter than the A/V interval set on the pacemaker.
- Recording from the atrial lead of a patient with atrial fibrillation
Atrial pacing
- AAI with ladder diagram
- AAI pacing 12 lead with a patient with Right Ventricular dysplasia taking Flecainide for ventricular tachycardia.
- A series of electrocardiograms from a 78 year old woman who was implanted with a VVI pacemaker in 1991. The patient developed congestive heart failure five years later due to pacemaker syndrome which was corrected by switching to atrial pacing.
- A patient with an atrial pacer that did not seem to pace properly.
- Two rhythm strips from a patient with an AAI.R pacemaker with atrial sensing of the QRS due to a prolonged PR interval.
- 12 lead electrocardiogram of a patient with right ventricular dysplasia and paced rhythm
- A rhythm strip from a patient that shows AAI pacing competing with and resetting the patient's nodal rhythm.
- Atrial pacing with competition from an accelerated ventricular rhythm causing fusion complexes
- An irregular rhythm with an atrial pacemaker.
Ventricular Pacing
- VVI with ladder diagram
- Ventricular paced rhythm with atrial flutter
- VVI pacing in patient with first degree A/V block
- Ventricular paced rhythm with atrial flutter after A/V nodal ablation.
- The effect of an acute myocardial infarction on the EKG of VVI pacing
- Failure to pace or a recording artifact? This is a recording from a patient with a Medtronic implantable defibrillator which also functions as a VVI pacemaker.
- Lead failure in a recently replaced VVI pacemaker.
- Escape/capture bigemini
- A rate responsive pacemaker with a respiratory sensor
- A recording showing rate hysteresis
- Pacing during ventricular fibrillation and failure to capture after a 360 joule shock.
Pacing conduction patterns
- A 12 lead electrocardiogram from a patient with a lead pacing the left ventricle.
- Tracings from a the same patient with right atrial appendage stimulation, R.V. septal and apical stimulation.
- A tracing from a patient with Mobitz I AV block where the AV conduction stops with VDD pacing even with a long sensed to paced interval of 300ms.
Pacemaker interactions
- A patient with two pacemakers, a DDD and a VVI .R which is at end of life
- Myopotential inhibition of a VVI.R pacemaker
- Suppression of a VVI pacemaker with an external pacemaker
Pacemaker Pacing Artifacts
- Bipolar ventricular paced rhythm with atrial flutter after A/V nodal ablation.
- Unipolar ventricular paced rhythm with atrial flutter
Pacemaker Follow-up
Unusual rhythms
- Bigemini with magnet over the pacemaker
- Bigemini with atrial threshold testing
- Conversion of atrial flutter with rapid atrial pacing followed by nodal rhythm
Threshold Testing
- 3 lead rhythm strip with DDD pacemaker and normal magnet response
- Pulse amplitude threshold testing for a ventricular pacemaker
Atrial threshold testing
- Atrial threshold testing in a DDD pacer using the AAI mode
- Atrial threshold testing in a model 2102 pacemaker
- PVCs interfering with ventricular threshold testing
- The effect of a long AV interval on atrial threshold testing of a DDD Pacer
- Threshold testing inducing asystole in a 21 year old patient with congenital complete heart block.
- Two pacemakers, DDD and VVI with atrial capture in one and ventricular in the other
Strength duration curves
Time dependent capture
- Example one (ventricular)
- Example two (ventricular)
- Example three (ventricular)
- Example four (ventricular)
- Example five (dual chamber pacer)
- Example six (dual chamber pacer)
Pacemaker system failure
- Pacemaker pacing failure and Mobitz II A/V block in a patient with a history of Torsade de Pointe and three degree heart block.
- A patient with a failing ventricular lead due to a subclavian crush.
Trans-telephonic EKG recordings
- Trans-telephonic pacemaker check failure to capture
- Trans-telephonic pacemaker check: Failure to capture. A patient in the high Arctic.
- Trans-telephonic pacemaker check at the MUHC (instructions)
Trans-telephonic Audio recordings
- The EKG and sound of a Medtronic VVI.P pacemaker with the magnet applied near the end of the recording
- Recording of end of life indication with magnet applied to VVI pacemaker
- A pacemaker that required inversion of the programming head for programming. The pacemaker could not be programmed in the usual manner in the pacemaker clinic. The pacemaker was implanted correctly with the conducting window toward the skin, but was a left-sided model which differed from the previous x-ray outline of the right-sided model. Having to invert the programming head suggests a problem with the programming head, inverted implantation of the pacemaker, or because the pacemaker electronics are functioning as a contra-lateral pacemaker.
Defibrillation and Cardioversion
External Cardioversion/defibrillation
- Recording of a series of shocks for Atrial Flutter
- Sinus pause post cardioversion for atrial fibrillation
- An irregular rhythm after cardioversion for atrial fibrillation
- pacing during ventricular fibrillation caused by cardioversion and failure to capture after a 360 joule shock.
Implantable Defibrillators
- Recording from a device during a spontaneous episode of ventricular fibrillation.
- P.A. chest film of a patient with an implantable defibrillator and an epicardial patch and S.V.C. spring electrode.
Threshold Testing
- Defibrillation threshold testing of an implantable defibrillator (successful) followed by ventricular paced rhythm.
- Defibrillation threshold testing of an implantable defibrillator (successful) followed by sinus rhythm.
- Defibrillation threshold testing of an implantable defibrillator (successful) followed by sinus rhythm. Recorded using an external defibrillator.
ECG Recordings
- An electrocardiogram from a patient with a cardiac myoplasty stimulator.
- A problem with atrial capture with a dual chamber pacemaker with a long A/V interval.
- A patient post pacemaker implant. for syncope
- A rate responsive pacemaker with respiratory sensor An ECG strip from the pacemaker clinic.
- A patient post DDD pacemaker implant ECG strip and images from a patient post DDD pacemaker implant.
- Patient with perforation of a temporary transvenous pacemaker Three EKGs and X-ray.
The Normal ECG
Super Puzzler
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