McGill Case 263: Difference between revisions

McGill Case 263 (view source)

266 bytes added , 19 February 2012

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-[[File:E263.jpg|thumb|600px|left|This is an important EKG. It shows the pacer working well, sensing the atrium and pacing the ventricle. Unfortunately the QRS morphology is very abnormal as it shows a RBBB with an extreme right axis deviation. This suggests that the lead is not in the right ventricle.
+[[File:E263.jpg|thumb|600px|left|This is a recording from a patient being treated for a wide complex tachycardia . The recording could be sinus with a first degree block (plus a partial right bundle branch block or possibly RVH). It is to be noted though that a sinus rate of 100/min seems some what fast for a patient on nadolol and that the rhythm is irregular.
-In this case it was felt that the lead was stimulating the left ventricle through a sinus-venosis atrial septal defect.]]
+On the other hand, the more likely rhyhtm is SVT (or slow atrial flutter at a rate of 200/min) with variable block though mostly 2:1 block. This is an atrial rate similar to that of the wide complex tachycardia, and if one looks in lead I and lead V1 there does appear to be atrial activity at twice the ventricular rate.
+]]