Sunday, January 25, 2015

ECG Blog #105 (ECG Video-Blog-8) Basics of AV Block


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This is the 8th installment of my ECG Video BlogThis 58-minute video covers the Basics of AV Block  including Pearls on ECG diagnosis — clinical relevance — and distinction from AV Dissociation.
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NOTE: There are advantages to using a video format format. These include:
  • Ability to illustrate concepts not done full justice by the written word.
  • Greater dispersion of my content through Google & YouTube. This material is free for anyone to use.
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LINKS to my ECG Video-Blog installments:
  • ECG Video-Blog #1-Revised (= Blog #95) — Is there AV Block?
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  • ECG Video-Blog #2 (= Blog #96) — Bundle Branch Blocks
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  • ECG Video-Blog #3 (= Blog #97) — SVT with marked ST Depression
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  • ECG Video-Blog #4 (= Blog #98) — Clinical Arrhythmia Mgmt (Part I )
  • ECG Video-Blog #5 (Blog #99) — Clinical Arrhythmia Mgmt (Part 2 )
  • ECG Video-Blog #6 (= Blog #100) — Clinical Arrhythmia Mgmt (Part 3 )
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  • ECG Video-Blog #7 (= Blog #101) — Wide Tachycardia + Chest Pain
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  • ECG Video-Blog #8 ( = Blog #105) — Basics of AV Block
  •    Easy YouTube Link for AV Block (www.avblockecg.com)
  •    Click Here for Timed Contents to the AV Block Video!
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  • ECG Video-Blog #9 ( = Blog #110) — Complete AV Block? / Laddergrams
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  • ECG Video-Blogs #10,11,12 ( Blog #113) — Rhythm Diagnosis Basics
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  • ECG Video-Blog #13 ( = Blog #116) — Essentials of Axis / Hemiblocks
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  • ECG Video-Blog #14 ( = Blog #117) — Brugada Syndrome
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  • ECG Video-Blog #15 ( = Blog #118) — QRST Changes
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  • ECG Video-Blog #16 ( = Blog #120) — Giant T Waves
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         My goal in this 58-minute video series is to review the approach to diagnosing the AV Blocks. This starts with recognizing what AV Block is (and is not— what conditions may mimic AV Block (ie, blocked PACs— and how to distinguish Complete AV Block from AV Dissociation. Focus is on the 3 types of 2nd-Degree AV Block (Mobitz I; Mobitz II; 2-to-1 AV Block— and on how to make a definitive diagnosis of Complete AV Block.
    • Below in Figure 1 — a sample of some issues discussed. I believe this video brings the topic to life!
    Figure-1: Slide reviewing the causes of AV Dissociation. The tracing illustrates Sinus Bradycardia with resultant AV Dissociation by "default" (ie, due to slowing of the sinus rate). NOTE — Enlarge by clicking on Figures — Right-Click to open in a separate window.
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    GTO – http://youtu.be/Ih5a1ER2umI - on YouTube to view this ECG Video (58 minutes). The "Easy" Link = www.avblockecg.com -
    • Click Here  — for a Timed CONTENTS of Video-Blog #8 on AV Blocks.
    • Please also check out my ECG Video Blog page on Google. The link is easy to remember = www.videoecg.com -
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    NOTE: For a Power Point Show (.ppsx) version of my Video Blogs - CLICK HERE. This folder will contain links to download a .ppsx version that allows faster viewing:
      • Download the .ppsx to your computer desktop.
      • The PPT show is without automatic sound. YOU activate only the Audio clips you want.
      • Hover your mouse over the highlighted Audio. You may play and/or pause if/as you like.
      • Feel free to use this .ppsx for teaching with my blessings!
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      Thursday, January 22, 2015

      ECG Blog #104 (My ECG Guru Comments-2) - AV Blocks/AV Dissociation

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      As a source of tracings for practice and/or teaching — I have decided to LINK many of the ECGs I have commented on as Contributing Expert for ECG Guru (www.ecgguru.com)
      • NOTE: The ECG Guru is dedicated to providing free resources for ECG Teachers and their StudentsSearch the ECG Guru site if you ever are in need of cases on a particular subject.
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      Regarding My Comments on the ECG Guru:
      = = = = = = = = = = = = = = = = = = = = = = = = =
      = = = = = = = = = = = = = = = = = = = = = = = = =

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      ECG for Comment #828  on the ECG Guru (Instructor Collection — posted 9/16/2014):
      This ECG was obtained from an 84-year old man who became dizzy and fell. He was not injured in the fall. Subsequent ECGs showed progressive slowing that clearly required insertion of a pacemaker.
      • How would you interpret this 12-lead ECG — given that this 84-year old man presented with syncope?
      • Is there complete AV Block?
      • Is there complete AV Dissociation? Are you certain?
      • What happens at the end of this 12-lead ECG?
      Figure-1: ECG obtained from an 84-year old man admitted for syncope. (Our gratitude to Sebastian Garay for use of this case and all tracings.).
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      ECG for Comment #836  on the ECG Guru (Instructor Collection — posted 11/4/2014):
      This ECG was obtained from an 62-year old man. Unfortunately, there is no clinical information available.
      • How would you interpret this 12-lead ECG and long lead II rhythm strip? 
      • Can you explain why the rhythm is irregular? (HINT — Why did I place this tracing with my ECG Guru Comments about AV block?)
      • Can you explain the change in QRS morphology?
      Figure-1: ECG obtained from an 62-year old man.  No history available ...
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      Sunday, January 18, 2015

      ECG Blog #103 (My ECG Guru Comments-1) - Acute MI Tracings

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      As a source of tracings for practice and/or teaching — I have decided to LINK many of the ECGs I have commented on as Contributing Expert for ECG Guru (www.ecgguru.com)
      • NOTE: The ECG Guru is dedicated to providing free resources for ECG Teachers and their Students. Search the ECG Guru site if you ever are in need of cases on a particular subject.
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      Regarding MComments on the ECG Guru:
      = = = = = = = = = = = = = = = = = = = = = = = = =
      = = = = = = = = = = = = = = = = = = = = = = = = =

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      ECG for Comment #848  on the ECG Guru (Instructor Collection — posted 1/16/2015):
      This ECG was obtained from a patient presenting to the ED (Emergency Department) with new-onset chest pain. Unfortunately No follow-up is available ...
      • How would you interpret this ECG — given that the patient has new-onset chest pain?
      • What is the "culprit" artery likely to be?
      Figure-1: ECG obtained from a patient with new-onset chest pain.
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      ECG for Comment #838  on the ECG Guru (Instructor Collection — posted 11/16/2014):
      This ECG was obtained from a patient with chest pain. Unfortunately  additional details are not available ...
      • How would you interpret this ECG — given the not unexpected history of chest pain?
      • What is the "culprit" artery likely to be?
      • Do the ECG findings shown here suggest LMain "disease"?
      Figure-1: ECG obtained from a patient with chest pain.
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      ECG for Comment #823  on the ECG Guru (Instructor Collection — posted 8/29/2014):
      This ECG was obtained from an 88-year old woman who presented to the ED (Emergency Department) in cariogenic shock. She apparently had been "ill" for several days prior to arrival in the ED.
      • What would you expect to find on cardiac catheterization? (Cath films are shown at the above link on ECG Guru).
      • Is all that you see on her ECG likely to be new?
      Figure-1: ECG obtained from an 88-year old woman who presented in cardiogenic shock. What would you expect to find on cath?
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      ECG for Comment #819  on the ECG Guru (Instructor Collection — posted 11/16/2014):
      This ECG was obtained from a patient found to have LMain occlusion on cath. Unfortunately  additional details are not available ...
      • Interpret the ECG. How many abnormal findings can you detect?
      • Comment on the cath findings.
      • Can one distinguish on ECG between proximal LAD vs LMain occlusion?
      Figure-1: ECG obtained from a patient with LMain occlusion. Are you surprised by this cath finding?
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      ECG for Comment #801  on the ECG Guru (Instructor Collection — posted 7/5/2014):
      The computer interpreted the rhythm for this tracing as, "AFib with PVCs"Unfortunately  additional details are not available ...
      • Do you agree with the computerized interpretation of the rhythm?
      • What else is going on?
      • Which arm should you check first on the patient? (ie, What is the likely source of the artifact?).
      Figure-1: ECG with lots of artifact ... Is the rhythm AFib (as the computer says)? What else is going on?
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