https://en.ecgpedia.org/index.php?title=Puzzle_2009_08_Answer&feed=atom&action=historyPuzzle 2009 08 Answer - Revision history2024-03-28T14:41:47ZRevision history for this page on the wikiMediaWiki 1.39.5https://en.ecgpedia.org/index.php?title=Puzzle_2009_08_Answer&diff=12289&oldid=prevDrj: /* Answer */2011-10-23T19:01:29Z<p><span dir="auto"><span class="autocomment">Answer</span></span></p>
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<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">Revision as of 19:01, 23 October 2011</td>
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<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>'''How would you judge this ECG?'''</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>'''How would you judge this ECG?'''</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Answer==</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Answer==</div></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>[[File:<del style="font-weight: bold; text-decoration: none;">Example</del>.jpg|thumb|Figure 2]]</div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>[[File:<ins style="font-weight: bold; text-decoration: none;">RhyrhmPuzzle2009_08_figure2</ins>.jpg|thumb|Figure 2]]</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>The ECG (precordial leads) shows an irregular rhythm without clearly discernable P waves. Atrial fibrillation is the most likely supraventricular rhythm. QRS complexes show a left bundle branch block pattern (LBBB) with the exception of the last but 5th QRS complex. This complex is narrow and has a normal morphology.</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>The ECG (precordial leads) shows an irregular rhythm without clearly discernable P waves. Atrial fibrillation is the most likely supraventricular rhythm. QRS complexes show a left bundle branch block pattern (LBBB) with the exception of the last but 5th QRS complex. This complex is narrow and has a normal morphology.</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>There are two potential explanations for this QRS complex. The first and probably most likely is that aberrant conduction occurs in the right bundle (concomitant conduction slowing in the contralateral bundle, the right bundle is contralateral to the left</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>There are two potential explanations for this QRS complex. The first and probably most likely is that aberrant conduction occurs in the right bundle (concomitant conduction slowing in the contralateral bundle, the right bundle is contralateral to the left</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>bundle that shows conduction delay in the other com- plexes) (figure 2). Indeed, aberrant conduction is most prevalent after the longest RR intervals during atrial fibrillation, as in this case. This relates to the longer refractory period of the bundles after a long preceding RR interval. The second possibility is ventricular ectopy in the ipsilateral bundle at the time that conduction passes through the right bundle. This possibility cannot be excluded. Ectopy should occur at the time that the supraventricular input reaches the site of the block. In both cases the QRS complex that ensues will mimic a normally conducted QRS complex.</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>bundle that shows conduction delay in the other com- plexes) (figure 2). Indeed, aberrant conduction is most prevalent after the longest RR intervals during atrial fibrillation, as in this case. This relates to the longer refractory period of the bundles after a long preceding RR interval. The second possibility is ventricular ectopy in the ipsilateral bundle at the time that conduction passes through the right bundle. This possibility cannot be excluded. Ectopy should occur at the time that the supraventricular input reaches the site of the block. In both cases the QRS complex that ensues will mimic a normally conducted QRS complex.</div></td></tr>
</table>Drjhttps://en.ecgpedia.org/index.php?title=Puzzle_2009_08_Answer&diff=12288&oldid=prevDrj at 19:00, 23 October 20112011-10-23T19:00:57Z<p></p>
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<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">Revision as of 19:00, 23 October 2011</td>
</tr><tr><td colspan="2" class="diff-lineno" id="mw-diff-left-l1">Line 1:</td>
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<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">{{NHJ|</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">|mainauthor= '''A.A.M. Wilde'''</ins></div></td></tr>
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<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">}}</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">[[File:Puzzle2009_08.jpg|thumb]]</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">A 95-year-old woman presents with palpitations. She has no relevant medical history and the present</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">complaint is several days old. She is not using any medication. Physical examination reveals an irregular</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">pulse and heart beat (pulse deficit 20 beats/min) and no further abnormalities. Her ECG is shown in figure 1</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">(only the precordial leads are shown). </ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">'''How would you judge this ECG?'''</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">==Answer==</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">[[File:Example.jpg|thumb|Figure 2]]</ins></div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>The ECG (precordial leads) shows an irregular rhythm without clearly discernable P waves. Atrial fibrillation is the most likely supraventricular rhythm. QRS complexes show a left bundle branch block pattern (LBBB) with the exception of the last but 5th QRS complex. This complex is narrow and has a normal morphology.</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>The ECG (precordial leads) shows an irregular rhythm without clearly discernable P waves. Atrial fibrillation is the most likely supraventricular rhythm. QRS complexes show a left bundle branch block pattern (LBBB) with the exception of the last but 5th QRS complex. This complex is narrow and has a normal morphology.</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>There are two potential explanations for this QRS complex. The first and probably most likely is that aberrant conduction occurs in the right bundle (concomitant conduction slowing in the contralateral bundle, the right bundle is contralateral to the left</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>There are two potential explanations for this QRS complex. The first and probably most likely is that aberrant conduction occurs in the right bundle (concomitant conduction slowing in the contralateral bundle, the right bundle is contralateral to the left</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>bundle that shows conduction delay in the other com- plexes) (figure 2). Indeed, aberrant conduction is most prevalent after the longest RR intervals during atrial fibrillation, as in this case. This relates to the longer refractory period of the bundles after a long preceding RR interval. The second possibility is ventricular ectopy in the ipsilateral bundle at the time that conduction passes through the right bundle. This possibility cannot be excluded. Ectopy should occur at the time that the supraventricular input reaches the site of the block. In both cases the QRS complex that ensues will mimic a normally conducted QRS complex.</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>bundle that shows conduction delay in the other com- plexes) (figure 2). Indeed, aberrant conduction is most prevalent after the longest RR intervals during atrial fibrillation, as in this case. This relates to the longer refractory period of the bundles after a long preceding RR interval. The second possibility is ventricular ectopy in the ipsilateral bundle at the time that conduction passes through the right bundle. This possibility cannot be excluded. Ectopy should occur at the time that the supraventricular input reaches the site of the block. In both cases the QRS complex that ensues will mimic a normally conducted QRS complex.</div></td></tr>
</table>Drjhttps://en.ecgpedia.org/index.php?title=Puzzle_2009_08_Answer&diff=12287&oldid=prevDrj at 19:00, 23 October 20112011-10-23T19:00:19Z<p></p>
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<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">Revision as of 19:00, 23 October 2011</td>
</tr><tr><td colspan="2" class="diff-lineno" id="mw-diff-left-l1">Line 1:</td>
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<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div> </div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">The ECG (precordial leads) shows an irregular rhythm without clearly discernable P waves. Atrial fibrillation is the most likely supraventricular rhythm. QRS complexes show a left bundle branch block pattern (LBBB) with the exception of the last but 5th QRS complex. This complex is narrow and has a normal morphology.</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">There are two potential explanations for this QRS complex. The first and probably most likely is that aberrant conduction occurs in the right bundle (concomitant conduction slowing in the contralateral bundle, the right bundle is contralateral to the left</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">bundle that shows conduction delay in the other com- plexes) (figure 2). Indeed, aberrant conduction is most prevalent after the longest RR intervals during atrial fibrillation, as in this case. This relates to the longer refractory period of the bundles after a long preceding RR interval. The second possibility is ventricular ectopy in the ipsilateral bundle at the time that conduction passes through the right bundle. This possibility cannot be excluded. Ectopy should occur at the time that the supraventricular input reaches the site of the block. In both cases the QRS complex that ensues will mimic a normally conducted QRS complex.</ins></div></td></tr>
</table>Drjhttps://en.ecgpedia.org/index.php?title=Puzzle_2009_08_Answer&diff=10001&oldid=prev77.249.193.120: Blanked the page2010-01-28T18:04:00Z<p>Blanked the page</p>
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</table>77.249.193.120https://en.ecgpedia.org/index.php?title=Puzzle_2009_08_Answer&diff=10000&oldid=prev94.99.157.198: Created page with 'ventricular fibrilation'2010-01-28T16:41:31Z<p>Created page with 'ventricular fibrilation'</p>
<p><b>New page</b></p><div>ventricular fibrilation</div>94.99.157.198