Case reports from Michael Rosengarten: Difference between revisions

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==Cardiac Pacemakers==
==Cardiac Pacemakers==
*[[McGill Case 98|A review of cardiac pacing]]  
*[[McGill Case 98|A review of cardiac pacing]]  
*[[McGill Case 42|Modes of cardiac pacing]]
*[[McGill Case 99|Modes of cardiac pacing]]
*[[McGill Case 42|Definitions of different pacing modes]]
*[[McGill Case 100|Definitions of different pacing modes]]


===Examples of different pacing modes===  
===Examples of different pacing modes===  
====DDD pacemakers====  
====DDD pacemakers====  
*[[McGill Case 42|DDD timing diagram in sinus rhythm with an AV delay of 80ms.]]  
*[[McGill Case 101|DDD timing diagram in sinus rhythm with an AV delay of 80ms.]]  
*[[McGill Case 42|DDD mode showing atrial and ventricular pacing and atrial sensing and venticular pacing.]]  
*[[McGill Case 102|DDD mode showing atrial and ventricular pacing and atrial sensing and venticular pacing.]]  
*[[McGill Case 42|DDD mode showing ventricular tracking of atrial fibrillation]]  
*[[McGill Case 103|DDD mode showing ventricular tracking of atrial fibrillation]]  
*[[McGill Case 42|DDI timing diagram in sinus rhythm and with one PVC with an AV delay of 80ms.]]  
*[[McGill Case 104|DDI timing diagram in sinus rhythm and with one PVC with an AV delay of 80ms.]]  
*[[McGill Case 42|DDI pacing at a lower rate of 50/min ]]
*[[McGill Case 105|DDI pacing at a lower rate of 50/min ]]
*[[McGill Case 42|DDD pacemaker recorded on a 12 lead EKG. Patient has a severe intraventricular conduction abnormality]]  
*[[McGill Case 106|DDD pacemaker recorded on a 12 lead EKG. Patient has a severe intraventricular conduction abnormality]]  
*[[McGill Case 42|DDD pacemaker at its upper rate limit in a patient with atrial fibrillation/flutter]]  
*[[McGill Case 107|DDD pacemaker at its upper rate limit in a patient with atrial fibrillation/flutter]]  
*[[McGill Case 42|DDD pacemaker failing to sense a P wave]]  
*[[McGill Case 108|DDD pacemaker failing to sense a P wave]]  
*[[McGill Case 42|DDD pacemaker the effect of a PVC on the timing cycles ]]
*[[McGill Case 109|DDD pacemaker the effect of a PVC on the timing cycles ]]
*[[McGill Case 42|DDD pacemaker timing diagram with atrial lead pacing the ventricle]]  
*[[McGill Case 110|DDD pacemaker timing diagram with atrial lead pacing the ventricle]]  
*[[McGill Case 42|A patient with atrial tachycardia with an intra-atrial recording from his pacemaker ]]
*[[McGill Case 111|A patient with atrial tachycardia with an intra-atrial recording from his pacemaker ]]
*[[McGill Case 42|Ladder diagrams and tracings while in DDI mode and complete heart block.]]  
*[[McGill Case 112|Ladder diagrams and tracings while in DDI mode and complete heart block.]]  
*[[McGill Case 42|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 113|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 42|Recording from the atrial lead of a patient with atrial fibrillation]]
*[[McGill Case 114|Recording from the atrial lead of a patient with atrial fibrillation]]


====Atrial pacing====  
====Atrial pacing====  
*[[McGill Case 42|AAI with ladder diagram]]  
*[[McGill Case 115|AAI with ladder diagram]]  
*[[McGill Case 42|AAI pacing 12 lead with a patient with Right Ventricular dysplasia taking Flecainide for ventricular tachycardia.]]
*[[McGill Case 116|AAI pacing 12 lead with a patient with Right Ventricular dysplasia taking Flecainide for ventricular tachycardia.]]
*[[McGill Case 42|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]]
*[[McGill Case 117|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]]
*[[McGill Case 42|later due to pacemaker syndrome which was corrected by switching to atrial pacing.]]  
*[[McGill Case 118|later due to pacemaker syndrome which was corrected by switching to atrial pacing.]]  
*[[McGill Case 42|A patient with an atrial pacer that did not seem to pace properly.]]  
*[[McGill Case 119|A patient with an atrial pacer that did not seem to pace properly.]]  
*[[McGill Case 42|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 120|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 42|12 lead electrocardiogram of a patient with right ventricular dysplasia and paced rhythm]]
*[[McGill Case 121|12 lead electrocardiogram of a patient with right ventricular dysplasia and paced rhythm]]
*[[McGill Case 42|A rhythm strip from a patient that shows AAI pacing competing with and resetting the patient's nodal rhythm.]]  
*[[McGill Case 122|A rhythm strip from a patient that shows AAI pacing competing with and resetting the patient's nodal rhythm.]]  
*[[McGill Case 42|Atrial pacing with competition from an accelerated ventricular rhythm causing fusion complexes]]  
*[[McGill Case 123|Atrial pacing with competition from an accelerated ventricular rhythm causing fusion complexes]]  
*[[McGill Case 42|An irregular rhythm with an atrial pacemaker.]]
*[[McGill Case 124|An irregular rhythm with an atrial pacemaker.]]
   
   
====Ventricular Pacing====  
====Ventricular Pacing====  
*[[McGill Case 42|VVI with ladder diagram]]  
*[[McGill Case 126|VVI with ladder diagram]]  
*[[McGill Case 42|Ventricular paced rhythm with atrial flutter]]  
*[[McGill Case 127|Ventricular paced rhythm with atrial flutter]]  
*[[McGill Case 42|VVI pacing in patient with first degree A/V block]]  
*[[McGill Case 128|VVI pacing in patient with first degree A/V block]]  
*[[McGill Case 42|Ventricular paced rhythm with atrial flutter after A/V nodal ablation.]]  
*[[McGill Case 129|Ventricular paced rhythm with atrial flutter after A/V nodal ablation.]]  
*[[McGill Case 42|The effect of an acute myocardial infarction on the EKG of VVI pacing]]  
*[[McGill Case 130|The effect of an acute myocardial infarction on the EKG of VVI pacing]]  
*[[McGill Case 42|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 131|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 42|Lead failure in a recently replaced VVI pacemaker.]]  
*[[McGill Case 132|Lead failure in a recently replaced VVI pacemaker.]]  
*[[McGill Case 42|Escape/capture bigemini]]  
*[[McGill Case 133|Escape/capture bigemini]]  
*[[McGill Case 42|A rate responsive pacemaker with a respiratory sensor]]  
*[[McGill Case 134|A rate responsive pacemaker with a respiratory sensor]]  
*[[McGill Case 42|A recording showing rate hysteresis]]  
*[[McGill Case 135|A recording showing rate hysteresis]]  
*[[McGill Case 42|pacing during ventricular fibrillation and failure to capture after a 360 joule shock.]]
*[[McGill Case 136|pacing during ventricular fibrillation and failure to capture after a 360 joule shock.]]
   
   
===Pacing conduction patterns===  
===Pacing conduction patterns===  
*[[McGill Case 42|A 12 lead electrocardiogram from a patient with a lead pacing the left ventricle.]]  
*[[McGill Case 137|A 12 lead electrocardiogram from a patient with a lead pacing the left ventricle.]]  
*[[McGill Case 42|Tracings from a the same patient with right atrial appendage stimulation, R.V. septal and apical stimulation.]]  
*[[McGill Case 138|Tracings from a the same patient with right atrial appendage stimulation, R.V. septal and apical stimulation.]]  
*[[McGill Case 42|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.]]
*[[McGill Case 139|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===
===Pacemaker interactions===
*[[McGill Case 42|A patient with two pacemakers, a DDD and a VVI .R which is at end of life]]  
*[[McGill Case 140|A patient with two pacemakers, a DDD and a VVI .R which is at end of life]]  
*[[McGill Case 42|Myopotential inhibition of a VVI.R pacemaker]]  
*[[McGill Case 141|Myopotential inhibition of a VVI.R pacemaker]]  
*[[McGill Case 42|Suppression of a VVI pacemaker with an external pacemaker]]
*[[McGill Case 142|Suppression of a VVI pacemaker with an external pacemaker]]
   
   
===Pacemaker Pacing Artifacts===
===Pacemaker Pacing Artifacts===
*[[McGill Case 42|Bipolar ventricular paced rhythm with atrial flutter after A/V nodal ablation.]]  
*[[McGill Case 143|Bipolar ventricular paced rhythm with atrial flutter after A/V nodal ablation.]]  
*[[McGill Case 42|Unipolar ventricular paced rhythm with atrial flutter]]  
*[[McGill Case 144|Unipolar ventricular paced rhythm with atrial flutter]]  


===Pacemaker Follow-up===  
===Pacemaker Follow-up===  
=====Unusual rhythms=====
=====Unusual rhythms=====
*[[McGill Case 42|Bigemini with magnet over the pacemaker]]  
*[[McGill Case 145|Bigemini with magnet over the pacemaker]]  
*[[McGill Case 42|Bigemini with atrial threshold testing]]  
*[[McGill Case 146|Bigemini with atrial threshold testing]]  
*[[McGill Case 42|conversion of atrial flutter with rapid atrial pacing followed by nodal rhythm ]]
*[[McGill Case 147|conversion of atrial flutter with rapid atrial pacing followed by nodal rhythm ]]


====Threshold Testing====  
====Threshold Testing====  
*[[McGill Case 42|3 lead rhythm strip with DDD pacemaker and normal magnet response]]  
*[[McGill Case 148|3 lead rhythm strip with DDD pacemaker and normal magnet response]]  
*[[McGill Case 42|Pulse amplitude threshold testing for a ventricular pacemaker]]  
*[[McGill Case 149|Pulse amplitude threshold testing for a ventricular pacemaker]]  
*[[McGill Case 42|Atrial threshold testing]]  
*[[McGill Case 150|Atrial threshold testing]]  
*[[McGill Case 42|Atrial threshold testing in a DDD pacer using the AAI mode]]  
*[[McGill Case 151|Atrial threshold testing in a DDD pacer using the AAI mode]]  
*[[McGill Case 42|Atrial threshold testing in a model 2102 pacemaker]]  
*[[McGill Case 152|Atrial threshold testing in a model 2102 pacemaker]]  
*[[McGill Case 42|PVCs interfering with ventricular threshold testing]]  
*[[McGill Case 153|PVCs interfering with ventricular threshold testing]]  
*[[McGill Case 42|The effect of a long AV interval on atrial threshold testing of a DDD Pacer]]
*[[McGill Case 154|The effect of a long AV interval on atrial threshold testing of a DDD Pacer]]
*[[McGill Case 42|Threshold testing inducing asystole in a 21 year old patient with congenital complete heart block.]]  
*[[McGill Case 155|Threshold testing inducing asystole in a 21 year old patient with congenital complete heart block.]]  
*[[McGill Case 42|Two pacemakers, DDD and VVI with atrial capture in one and ventricular in the other]]  
*[[McGill Case 156|Two pacemakers, DDD and VVI with atrial capture in one and ventricular in the other]]  


====Strength duration curves====
====Strength duration curves====
*[[McGill Case 42|A strength/duration curve from an atrial lead.]]  
*[[McGill Case 157|A strength/duration curve from an atrial lead.]]  
*[[McGill Case 42|A strength/duration curve from a ventricular lead.]]
*[[McGill Case 158|A strength/duration curve from a ventricular lead.]]
   
   
====Time dependent capture====  
====Time dependent capture====  
====Pacemaker system failure====  
====Pacemaker system failure====  
*[[McGill Case 42|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 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 42|A patient with a failing ventricular lead due to a subclavian crush.]]  
*[[McGill Case 160|A patient with a failing ventricular lead due to a subclavian crush.]]  


====Trans-telephonic EKG recordings====  
====Trans-telephonic EKG recordings====  
*[[McGill Case 42|Trans-telephonic pacemaker check failure to capture]]  
*[[McGill Case 161|Trans-telephonic pacemaker check failure to capture]]  
*[[McGill Case 42|Trans-telephonic pacemaker check: Failure to capture. A patient in the high Arctic.]]  
*[[McGill Case 162|Trans-telephonic pacemaker check: Failure to capture. A patient in the high Arctic.]]  
*[[McGill Case 42|Trans-telephonic pacemaker check at the MUHC (instructions)]]
*[[McGill Case 163|Trans-telephonic pacemaker check at the MUHC (instructions)]]
   
   
====Trans-telephonic Audio recordings====  
====Trans-telephonic Audio recordings====  
*[[McGill Case 42|The EKG and sound of a Medtronic VVI.P pacemaker with the magnet applied near the end of the recording]]  
*[[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 42|Recording of end of life indication with magnet applied to VVI pacemaker]]  
*[[McGill Case 165|Recording of end of life indication with magnet applied to VVI pacemaker]]  
*[[McGill Case 42|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.]]  
*[[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.]]  
*[[McGill Case 42|Lecture on pacemaker follow-up November 1998]]
*[[McGill Case 167|Lecture on pacemaker follow-up November 1998]]


===Defibrillation and Cardioversion===
===Defibrillation and Cardioversion===
====External Cardioversion/defibrillation====  
====External Cardioversion/defibrillation====  
*[[McGill Case 42|Recording of a series of shocks for Atrial Flutter]]  
*[[McGill Case 168|Recording of a series of shocks for Atrial Flutter]]  
*[[McGill Case 42|Sinus pause post cardioversion for atrial fibrillation ]]
*[[McGill Case 169|Sinus pause post cardioversion for atrial fibrillation ]]
*[[McGill Case 42|An irregular rhythm after cardioversion for atrial fibrillation]]  
*[[McGill Case 170|An irregular rhythm after cardioversion for atrial fibrillation]]  
*[[McGill Case 42|pacing during ventricular fibrillation caused by cardioversion and failure to capture after a 360 joule shock.]]  
*[[McGill Case 171|pacing during ventricular fibrillation caused by cardioversion and failure to capture after a 360 joule shock.]]  


====Implantable Defibrillators====  
====Implantable Defibrillators====  
*[[McGill Case 42|Recording from a device during a spontaneous episode of ventricular fibrillation.]]  
*[[McGill Case 172|Recording from a device during a spontaneous episode of ventricular fibrillation.]]  
*[[McGill Case 42|P.A. chest film of a patient with an implantable defibrillator and an epicardial patch and S.V.C. spring electrode.]]  
*[[McGill Case 173|P.A. chest film of a patient with an implantable defibrillator and an epicardial patch and S.V.C. spring electrode.]]  


=====Threshold Testing=====  
=====Threshold Testing=====  
*[[McGill Case 42|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 ventricular paced rhythm.]]  
*[[McGill Case 42|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.]]  
*[[McGill Case 42|Defibrillation threshold testing of an implantable defibrillator (successful) followed by sinus rhythm. Recorded using an external defibrillator.]]  
*[[McGill Case 176|Defibrillation threshold testing of an implantable defibrillator (successful) followed by sinus rhythm. Recorded using an external defibrillator.]]  


===EKG Recordings===
===EKG Recordings===
*[[McGill Case 42|An electrocardiogram from a patient with a cardiac myoplasty stimulator.]]  
*[[McGill Case 177|An electrocardiogram from a patient with a cardiac myoplasty stimulator.]]  
*[[McGill Case 42|A problem with atrial capture with a dual chamber pacemaker with a long A/V interval.]]  
*[[McGill Case 178|A problem with atrial capture with a dual chamber pacemaker with a long A/V interval.]]  
*[[McGill Case 42|A patient post pacemaker implant. for syncope]]  
*[[McGill Case 179|A patient post pacemaker implant. for syncope]]  
*[[McGill Case 42|A rate responsive pacemaker with respiratory sensor An ECG strip from the pacemaker clinic.]]  
*[[McGill Case 180|A rate responsive pacemaker with respiratory sensor An ECG strip from the pacemaker clinic.]]  
*[[McGill Case 42|A patient post DDD pacemaker implant ECG strip and images from a patient post DDD pacemaker implant.]]
*[[McGill Case 181|A patient post DDD pacemaker implant ECG strip and images from a patient post DDD pacemaker implant.]]
*[[McGill Case 42|Patient with perforation of a temporary transvenous pacemaker Three EKGs and X-ray.]]
*[[McGill Case 182|Patient with perforation of a temporary transvenous pacemaker Three EKGs and X-ray.]]

Revision as of 07:09, 15 February 2012

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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

Right Bundle Branch Block

Left Bundle Branch Block

Left Anterior Fasicular Block

Left Posterior Fasicular Block

Bifasicular block

Right bundle branch block with left anterior hemi-block

Right bundle branch block with left posterior hemi-block

Alternating Bundle Branch Block

Trifasicular block

A/V Blocks

First degree block:

Second degree block

Mobitz I

Mobitz II

Complete heart block

Sinus Node Block:


Arrhythmias

Supraventricular Arrhythmias

Sinus pauses

Premature atrial complexes

Atrial fibrillation

Supraventricular Tachycardia

Without block
With block

Atrial Flutter

Nodal Rhythm:

Accelerated nodal rhythm

Wolf Parkinson White

Other atrial rhythms

Ventricular Arrhythmias

Premature Complexes

Bigemini

Ventricular Tachycardia

Ventricular Fibrillation

Cardiac Pacemakers

Examples of different pacing modes

DDD pacemakers

Atrial pacing

Ventricular Pacing

Pacing conduction patterns

Pacemaker interactions

Pacemaker Pacing Artifacts

Pacemaker Follow-up

Unusual rhythms

Threshold Testing

Strength duration curves

Time dependent capture

Pacemaker system failure

Trans-telephonic EKG recordings

Trans-telephonic Audio recordings

Defibrillation and Cardioversion

External Cardioversion/defibrillation

Implantable Defibrillators

Threshold Testing

EKG Recordings