McGill Case 66: Difference between revisions

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-[[File:E0007661.jpg|thumb|600px|left|The first tracing was recorded in the emergency room, and is from a 70 year old woman with two sycopal attacks. She was on metoprolol and diltiazem for angina {normal coronaries and an abnormal MIBI perfusion scan}.]]
+[[File:E0007661.jpg|thumb|600px|left|This is an interesting set of tracings, as it shows the effect of adenosine on AV conduction, but in addition the effect on atrial refractoriness.
+The first tracing is clearly atrial flutter with an atrial rate of 270/min, and a ventricular rate of 135/min. The second recording shows much faster atrial activity (Note the distance between the turquoise arrows and the yellow arrows which mark out 3 atrial cycles). The second tracing is either atrial fibrillation (a know result of adenosine) or a faster atrial flutter (type II flutter) with variable block. Both of these effects could be seen as a result of the decrease in the atrial refractory period by the stimulation of the adenosine.]]
-[[File:E0007662.jpg|thumb|600px|left|This tracing was taken in the intensive care unit after a temporary pacing wire (soft semi-floater) was placed via the right internal jugular vein. The lead paced the ventricle well, but the patient immediately complained of moderate chest pain, better with sitting up.]]
+[[File:E0007662.jpg|thumb|600px|left|]]
-[[File:E0007663.jpg|thumb|600px|left|This was an X-ray taken the day after the insertion of the temporary pacing lead. The patient continued to have chest pain.]]
-[[File:E0007664.jpg|thumb|600px|left|This cardiogram was taken at the peak of the chest pain.]]