Answer to Case Number 2 - We have had several attempts at diagnosing this ECG and though many have come close, no one noted the presence of the combined electrolyte disturbance. This patient's Potassium level was 2.2 noted by the giant positive U wave best seen in V4-V5 immediately following a negative T wave (most notable in V4). In addition the patients Calcium level was 3.1 noted by the widespread prolonged ST segment greater than the norm of 0.08 to a maximum of 0.12 sec. This feature is seen in all leads of the ECG giving the impression that the QT is prolonged, which it is, but the problem is a prolonged ST, which gives way to a prolonged QT interval. In addition there is also widespread ST-T depression suggestive of myocardial ischemia.
Case Study No. 2 - Posted on July 18, 2017 The ABCM is offering a free ECG Lesson to the Technician or Nurse that can tell us what the ECG above represents. Send responses to jcooper@abcmcertification.com. We will change this ECG out after we get the right answer and post another one for your analysis. A great way to brush up on some very interesting ECGs, enjoy the challenge.
Your ECG Tutor...Jonni Cooper
See Answer to the previous ECG and the winner at the bottom of this page.
Case Study No. 2 - Posted on July 18, 2017 The ABCM is offering a free ECG Lesson to the Technician or Nurse that can tell us what the ECG above represents. Send responses to jcooper@abcmcertification.com. We will change this ECG out after we get the right answer and post another one for your analysis. A great way to brush up on some very interesting ECGs, enjoy the challenge.
Your ECG Tutor...Jonni Cooper
See Answer to the previous ECG and the winner at the bottom of this page.
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Answer to previous ECG Posted on July 18, 2017:
Answer to quiz number 26 posted July 12, 2017 was answered correctly by Joseph Ponce de Leon, CMT from Houston, TX and here is the correct answer:
Answer to quiz number 26 posted July 12, 2017 was answered correctly by Joseph Ponce de Leon, CMT from Houston, TX and here is the correct answer:
Answer to previous ECG posted on July 12, 2017:
Answer to quiz number 26 posted July 12, 2017 was answered correctly by Joseph Ponce de Leon, CMT from Houston, TX and here is the correct answer:
The underlying rhythm is a sinus rhythm with a rate of approximately 68bpm. There is a probable recent or old septal injury evidence by the loss of the initial "r" wave and a slightly bulging ST segment. There may also be an incomplete LBBB due to the width of the QRS being about 0.10-0.11 seconds in duration. Then there is an accelerated left ventricular rhythm that usurps control of the ventricles at a rate of about 69-70bpm (slightly faster than the sinus). The QRS morphology is a qR complex which is classic for a left ventricular rhythm. The treatment of choice would be to do nothing, just keep an eye on the patient's blood pressure and this rhythm generally self terminates. Accelerated ventricular rhythms generally do not cause hemodynamic compromise and generally self terminate. If you try to terminate it, the result could be disastrous leaving the patient with no rhythm at all.
Answer to quiz number 26 posted July 12, 2017 was answered correctly by Joseph Ponce de Leon, CMT from Houston, TX and here is the correct answer:
The underlying rhythm is a sinus rhythm with a rate of approximately 68bpm. There is a probable recent or old septal injury evidence by the loss of the initial "r" wave and a slightly bulging ST segment. There may also be an incomplete LBBB due to the width of the QRS being about 0.10-0.11 seconds in duration. Then there is an accelerated left ventricular rhythm that usurps control of the ventricles at a rate of about 69-70bpm (slightly faster than the sinus). The QRS morphology is a qR complex which is classic for a left ventricular rhythm. The treatment of choice would be to do nothing, just keep an eye on the patient's blood pressure and this rhythm generally self terminates. Accelerated ventricular rhythms generally do not cause hemodynamic compromise and generally self terminate. If you try to terminate it, the result could be disastrous leaving the patient with no rhythm at all.
Answer to previous ECG posted on July 4th, 2017:
Answer to quiz number 1 posted on July 4th, 2017 was answered correctly by Rex Ambatali, Jr., a NP from Elk Grove, CA, and here is the correct answer:
The rhythm represents Sinus Bradycardia with a heart rate of approximately 52 bpm.
Atrial premature beats with incomplete right bundle branch block since the QRS interval is approximately 0.10 sec.
The post ectopic cycles are more than compensatory.
The loss of an initial R wave in a V1 lead does suggest the possibility of an old septal injury.
The primary T wave changes seen in the atrial premature beats with right bundle branch block suggest the presence of myocardial ischemia of the anterior wall.
Answer to quiz number 1 posted on July 4th, 2017 was answered correctly by Rex Ambatali, Jr., a NP from Elk Grove, CA, and here is the correct answer:
The rhythm represents Sinus Bradycardia with a heart rate of approximately 52 bpm.
Atrial premature beats with incomplete right bundle branch block since the QRS interval is approximately 0.10 sec.
The post ectopic cycles are more than compensatory.
The loss of an initial R wave in a V1 lead does suggest the possibility of an old septal injury.
The primary T wave changes seen in the atrial premature beats with right bundle branch block suggest the presence of myocardial ischemia of the anterior wall.
