Case reports from Michael Rosengarten: Difference between revisions

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===Sinus Node Block:===
===Sinus Node Block:===
*[[McGill Case 42|A middle aged woman treated for atrial fibrillation with a possible sinus node exit block (Mobitz 1)]]
*[[McGill Case 42|A middle aged woman treated for atrial fibrillation with a possible sinus node exit block (Mobitz 1)]]


==Arrhythmias==
==Arrhythmias==
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*[[McGill Case 97|A 70 year old woman with recurrent ventricular tachycardia and a severe intra-ventricular conduction defect.]]
*[[McGill Case 97|A 70 year old woman with recurrent ventricular tachycardia and a severe intra-ventricular conduction defect.]]


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


===Examples of different pacing modes===  
===Cardiac Pacemakers===
====DDD pacemakers====  
====Examples of different pacing modes====  
*[[McGill Case 101|DDD timing diagram in sinus rhythm with an AV delay of 80ms.]]  
=====DDD pacemakers=====  
*[[McGill Case 102|DDD mode showing atrial and ventricular pacing and atrial sensing and venticular pacing.]]  
*[[McGill Case 98|DDD timing diagram in sinus rhythm with an AV delay of 80ms.]]  
*[[McGill Case 103|DDD mode showing ventricular tracking of atrial fibrillation]]  
*[[McGill Case 99|DDD mode showing atrial and ventricular pacing and atrial sensing and venticular pacing.]]  
*[[McGill Case 104|DDI timing diagram in sinus rhythm and with one PVC with an AV delay of 80ms.]]  
*[[McGill Case 100|DDD mode showing ventricular tracking of atrial fibrillation]]  
*[[McGill Case 105|DDI pacing at a lower rate of 50/min ]]
*[[McGill Case 101|DDI timing diagram in sinus rhythm and with one PVC with an AV delay of 80ms.]]  
*[[McGill Case 106|DDD pacemaker recorded on a 12 lead EKG. Patient has a severe intraventricular conduction abnormality]]  
*[[McGill Case 102|DDI pacing at a lower rate of 50/min ]]
*[[McGill Case 107|DDD pacemaker at its upper rate limit in a patient with atrial fibrillation/flutter]]  
*[[McGill Case 103|DDD pacemaker recorded on a 12 lead EKG. Patient has a severe intraventricular conduction abnormality]]  
*[[McGill Case 108|DDD pacemaker failing to sense a P wave]]  
*[[McGill Case 104|DDD pacemaker at its upper rate limit in a patient with atrial fibrillation/flutter]]  
*[[McGill Case 109|DDD pacemaker the effect of a PVC on the timing cycles ]]
*[[McGill Case 105|DDD pacemaker failing to sense a P wave]]  
*[[McGill Case 110|DDD pacemaker timing diagram with atrial lead pacing the ventricle]]  
*[[McGill Case 106|DDD pacemaker the effect of a PVC on the timing cycles ]]
*[[McGill Case 111|A patient with atrial tachycardia with an intra-atrial recording from his pacemaker ]]
*[[McGill Case 107|DDD pacemaker timing diagram with atrial lead pacing the ventricle]]  
*[[McGill Case 112|Ladder diagrams and tracings while in DDI mode and complete heart block.]]  
*[[McGill Case 108|A patient with atrial tachycardia with an intra-atrial recording from his 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 109|Ladder diagrams and tracings while in DDI mode and complete heart block.]]  
*[[McGill Case 114|Recording from the atrial lead of a patient with atrial fibrillation]]
*[[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====  
=====Atrial pacing=====  
*[[McGill Case 115|AAI with ladder diagram]]  
*[[McGill Case 112|AAI with ladder diagram]]  
*[[McGill Case 116|AAI pacing 12 lead with a patient with Right Ventricular dysplasia taking Flecainide for ventricular tachycardia.]]
*[[McGill Case 113|AAI pacing 12 lead with a patient with Right Ventricular dysplasia taking Flecainide for ventricular tachycardia.]]
*[[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 later due to pacemaker syndrome which was corrected by switching to atrial pacing.]]  
*[[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 118|A patient with an atrial pacer that did not seem to pace properly.]]  
*[[McGill Case 115|A patient with an atrial pacer that did not seem to pace properly.]]  
*[[McGill Case 119|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 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 120|12 lead electrocardiogram of a patient with right ventricular dysplasia and paced rhythm]]
*[[McGill Case 117|12 lead electrocardiogram of a patient with right ventricular dysplasia and paced rhythm]]
*[[McGill Case 121|A rhythm strip from a patient that shows AAI pacing competing with and resetting the patient's nodal 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 122|Atrial pacing with competition from an accelerated ventricular rhythm causing fusion complexes]]  
*[[McGill Case 119|Atrial pacing with competition from an accelerated ventricular rhythm causing fusion complexes]]  
*[[McGill Case 123|An irregular rhythm with an atrial pacemaker.]]
*[[McGill Case 120|An irregular rhythm with an atrial pacemaker.]]


====Ventricular Pacing====  
=====Ventricular Pacing=====  
*[[McGill Case 126|VVI with ladder diagram]]  
*[[McGill Case 121|VVI with ladder diagram]]  
*[[McGill Case 127|Ventricular paced rhythm with atrial flutter]]  
*[[McGill Case 122|Ventricular paced rhythm with atrial flutter]]  
*[[McGill Case 128|VVI pacing in patient with first degree A/V block]]  
*[[McGill Case 123|VVI pacing in patient with first degree A/V block]]  
*[[McGill Case 129|Ventricular paced rhythm with atrial flutter after A/V nodal ablation.]]  
*[[McGill Case 124|Ventricular paced rhythm with atrial flutter after A/V nodal ablation.]]  
*[[McGill Case 130|The effect of an acute myocardial infarction on the EKG of VVI pacing]]  
*[[McGill Case 125|The effect of an acute myocardial infarction on the EKG of VVI pacing]]  
*[[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 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 132|Lead failure in a recently replaced VVI pacemaker.]]  
*[[McGill Case 127|Lead failure in a recently replaced VVI pacemaker.]]  
*[[McGill Case 133|Escape/capture bigemini]]  
*[[McGill Case 128|Escape/capture bigemini]]  
*[[McGill Case 134|A rate responsive pacemaker with a respiratory sensor]]  
*[[McGill Case 129|A rate responsive pacemaker with a respiratory sensor]]  
*[[McGill Case 135|A recording showing rate hysteresis]]  
*[[McGill Case 130|A recording showing rate hysteresis]]  
*[[McGill Case 136|Pacing during ventricular fibrillation and failure to capture after a 360 joule shock.]]
*[[McGill Case 131|Pacing during ventricular fibrillation and failure to capture after a 360 joule shock.]]


===Pacing conduction patterns===  
====Pacing conduction patterns====  
*[[McGill Case 137|A 12 lead electrocardiogram from a patient with a lead pacing the left ventricle.]]  
*[[McGill Case 132|A 12 lead electrocardiogram from a patient with a lead pacing the left ventricle.]]  
*[[McGill Case 138|Tracings from a the same patient with right atrial appendage stimulation, R.V. septal and apical stimulation.]]  
*[[McGill Case 133|Tracings from a the same patient with right atrial appendage stimulation, R.V. septal and apical stimulation.]]  
*[[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.]]
*[[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===
====Pacemaker interactions====
*[[McGill Case 140|A patient with two pacemakers, a DDD and a VVI .R which is at end of life]]  
*[[McGill Case 135|A patient with two pacemakers, a DDD and a VVI .R which is at end of life]]  
*[[McGill Case 141|Myopotential inhibition of a VVI.R pacemaker]]  
*[[McGill Case 136|Myopotential inhibition of a VVI.R pacemaker]]  
*[[McGill Case 142|Suppression of a VVI pacemaker with an external pacemaker]]
*[[McGill Case 137|Suppression of a VVI pacemaker with an external pacemaker]]
   
   
===Pacemaker Pacing Artifacts===
====Pacemaker Pacing Artifacts====
*[[McGill Case 143|Bipolar ventricular paced rhythm with atrial flutter after A/V nodal ablation.]]  
*[[McGill Case 138|Bipolar ventricular paced rhythm with atrial flutter after A/V nodal ablation.]]  
*[[McGill Case 144|Unipolar ventricular paced rhythm with atrial flutter]]  
*[[McGill Case 139|Unipolar ventricular paced rhythm with atrial flutter]]  


===Pacemaker Follow-up===  
====Pacemaker Follow-up====  
====Unusual rhythms====
=====Unusual rhythms=====
*[[McGill Case 145|Bigemini with magnet over the pacemaker]]  
*[[McGill Case 140|Bigemini with magnet over the pacemaker]]  
*[[McGill Case 146|Bigemini with atrial threshold testing]]  
*[[McGill Case 141|Bigemini with atrial threshold testing]]  
*[[McGill Case 147|Conversion of atrial flutter with rapid atrial pacing followed by nodal rhythm ]]
*[[McGill Case 142|Conversion of atrial flutter with rapid atrial pacing followed by nodal rhythm ]]


====Threshold Testing====  
=====Threshold Testing=====  
*[[McGill Case 148|3 lead rhythm strip with DDD pacemaker and normal magnet response]]  
*[[McGill Case 143|3 lead rhythm strip with DDD pacemaker and normal magnet response]]  
*[[McGill Case 149|Pulse amplitude threshold testing for a ventricular pacemaker]]  
*[[McGill Case 144|Pulse amplitude threshold testing for a ventricular pacemaker]]
*[[McGill Case 150|Atrial threshold testing]]
*[[McGill Case 151|Atrial threshold testing in a DDD pacer using the AAI mode]]  
======Atrial threshold testing======
*[[McGill Case 152|Atrial threshold testing in a model 2102 pacemaker]]  
*[[McGill Case 145|Atrial threshold testing in a DDD pacer using the AAI mode]]  
*[[McGill Case 153|PVCs interfering with ventricular threshold testing]]  
*[[McGill Case 146|Atrial threshold testing in a model 2102 pacemaker]]  
*[[McGill Case 154|The effect of a long AV interval on atrial threshold testing of a DDD Pacer]]
*[[McGill Case 147|PVCs interfering with ventricular threshold testing]]  
*[[McGill Case 155|Threshold testing inducing asystole in a 21 year old patient with congenital complete heart block.]]  
*[[McGill Case 148|The effect of a long AV interval on atrial threshold testing of a DDD Pacer]]
*[[McGill Case 156|Two pacemakers, DDD and VVI with atrial capture in one and ventricular in the other]]  
*[[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====
=====Strength duration curves=====
*[[McGill Case 157|A strength/duration curve from an atrial lead.]]  
*[[McGill Case 151|A strength/duration curve from an atrial lead.]]  
*[[McGill Case 158|A strength/duration curve from a ventricular lead.]]
*[[McGill Case 152|A strength/duration curve from a ventricular lead.]]
   
   
====Time dependent capture====  
=====Time dependent capture=====
====Pacemaker system failure====  
 
 
*[[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 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.]]  
*[[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 161|Trans-telephonic pacemaker check failure to capture]]  
*[[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 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)]]
*[[McGill Case 163|Trans-telephonic pacemaker check at the MUHC (instructions)]]
   
   
====Trans-telephonic Audio recordings====  
=====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 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 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.]]  
*[[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 167|Lecture on pacemaker follow-up November 1998]]


===Defibrillation and Cardioversion===
===Defibrillation and Cardioversion===
====External Cardioversion/defibrillation====  
=====External Cardioversion/defibrillation=====  
*[[McGill Case 168|Recording of a series of shocks for Atrial Flutter]]  
*[[McGill Case 167|Recording of a series of shocks for Atrial Flutter]]  
*[[McGill Case 169|Sinus pause post cardioversion for atrial fibrillation ]]
*[[McGill Case 168|Sinus pause post cardioversion for atrial fibrillation ]]
*[[McGill Case 170|An irregular rhythm after cardioversion for atrial fibrillation]]  
*[[McGill Case 169|An irregular rhythm after cardioversion for atrial fibrillation]]  
*[[McGill Case 171|pacing during ventricular fibrillation caused by cardioversion and failure to capture after a 360 joule shock.]]  
*[[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.]]  


====Implantable Defibrillators====  
===ECG Recordings===
*[[McGill Case 172|Recording from a device during a spontaneous episode of ventricular fibrillation.]]  
*[[McGill Case 176|An electrocardiogram from a patient with a cardiac myoplasty stimulator.]]  
*[[McGill Case 173|P.A. chest film of a patient with an implantable defibrillator and an epicardial patch and S.V.C. spring electrode.]]  
*[[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.]]


=====Threshold Testing=====
==The Normal ECG==
*[[McGill Case 174|Defibrillation threshold testing of an implantable defibrillator (successful) followed by ventricular paced rhythm.]]  
*[[McGill Case 182|Case One]]
*[[McGill Case 175|Defibrillation threshold testing of an implantable defibrillator (successful) followed by sinus rhythm.]]  
*[[McGill Case 183|Case Two]]
*[[McGill Case 176|Defibrillation threshold testing of an implantable defibrillator (successful) followed by sinus rhythm. Recorded using an external defibrillator.]]  
*[[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]]


===EKG Recordings===
==Super Puzzler==
*[[McGill Case 177|An electrocardiogram from a patient with a cardiac myoplasty stimulator.]]  
*[[McGill Case 191|1]]
*[[McGill Case 178|A problem with atrial capture with a dual chamber pacemaker with a long A/V interval.]]  
*[[McGill Case 192|2]]
*[[McGill Case 179|A patient post pacemaker implant. for syncope]]  
*[[McGill Case 193|3]]
*[[McGill Case 180|A rate responsive pacemaker with respiratory sensor An ECG strip from the pacemaker clinic.]]  
*[[McGill Case 194|4]]
*[[McGill Case 181|A patient post DDD pacemaker implant ECG strip and images from a patient post DDD pacemaker implant.]]
*[[McGill Case 195|5]]
*[[McGill Case 182|Patient with perforation of a temporary transvenous pacemaker Three EKGs and X-ray.]]
*[[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]]
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*[[McGill Case 358|168]]
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*[[McGill Case 403|213]]
*[[McGill Case 404|214]]
*[[McGill Case 405|215]]

Latest revision as of 23:30, 19 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

Implanted Devices

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
Atrial 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

ECG Recordings

The Normal ECG

Super Puzzler