Advanced ECG Grand Rounds:
The Advanced ECG Grand Rounds is a series of Advanced level cases that we are now hosting free on the first and third Tuesdays of every month. They were designed for interaction among Physicians, Nurse Practitioners, and Advanced Cardiac Nurses, and ECG Techs; monitor techs are welcomed.
Feel free to log in and learn from the cases and/or submit your diagnoses and thoughts.
How it Works:
We will post all answers submitted in the two week period so that participants can see what their colleagues are diagnosing. As soon as someone gets the most complete answer, we will post it along with our rationale below.
However, if no one gets the answer correct in the allotted time frame of 2 weeks, the answer along with our rationale will be provided.
Enjoy, and please provide your feedback whether you agree or disagree with the diagnoses we make. We can always provide references for our answers and welcome yours.
The Advanced ECG Grand Rounds is a series of Advanced level cases that we are now hosting free on the first and third Tuesdays of every month. They were designed for interaction among Physicians, Nurse Practitioners, and Advanced Cardiac Nurses, and ECG Techs; monitor techs are welcomed.
Feel free to log in and learn from the cases and/or submit your diagnoses and thoughts.
How it Works:
We will post all answers submitted in the two week period so that participants can see what their colleagues are diagnosing. As soon as someone gets the most complete answer, we will post it along with our rationale below.
However, if no one gets the answer correct in the allotted time frame of 2 weeks, the answer along with our rationale will be provided.
Enjoy, and please provide your feedback whether you agree or disagree with the diagnoses we make. We can always provide references for our answers and welcome yours.
Case No. 1 - Advanced ECG Grand Rounds - Posted May 10, 2021
This 69 year old female presented with underlying heart failure complained of having a troubling fast heart beat all too often.
You record this ECG and find the disturbance below.
1. What is your diagnosis?
2. What is your evidence?
Submit your answer in the Entry Form below.
You record this ECG and find the disturbance below.
1. What is your diagnosis?
2. What is your evidence?
Submit your answer in the Entry Form below.
Advanced ECG Grand Rounds Case #1 Answers submitted:
12-Lead and Arrhythmia ECG Grand Rounds:
The 12-Lead and Arrhythmia ECG Grand Rounds is a series of intermediate level cases that we are now hosting free on the first and third Tuesdays of every month. They were designed for interaction among Physicians, Nurse Practitioners, and Advanced Cardiac Nurses, and ECG Techs; monitor techs are welcomed.
Feel free to log in and learn from the cases and/or submit your diagnoses and thoughts.
How it Works:
We will post all answers submitted in the two week period so that participants can see what their colleagues are diagnosing. As soon as someone gets the most complete answer, we will post it along with our rationale below.
However, if no one gets the answer correct in the allotted time frame of 2 weeks, the answer along with our rationale will be provided.
Enjoy, and please provide your feedback whether you agree or disagree with the diagnoses we make. We can always provide references for our answers and welcome yours.
The 12-Lead and Arrhythmia ECG Grand Rounds is a series of intermediate level cases that we are now hosting free on the first and third Tuesdays of every month. They were designed for interaction among Physicians, Nurse Practitioners, and Advanced Cardiac Nurses, and ECG Techs; monitor techs are welcomed.
Feel free to log in and learn from the cases and/or submit your diagnoses and thoughts.
How it Works:
We will post all answers submitted in the two week period so that participants can see what their colleagues are diagnosing. As soon as someone gets the most complete answer, we will post it along with our rationale below.
However, if no one gets the answer correct in the allotted time frame of 2 weeks, the answer along with our rationale will be provided.
Enjoy, and please provide your feedback whether you agree or disagree with the diagnoses we make. We can always provide references for our answers and welcome yours.
Case No. 1 - 12-Lead and Arrhythmia ECG Grand Rounds - Posted April 21, 2021
This 65-year old woman had a five-year history of angina and was admitted to the CCU with palpitations and chest pain.
Her blood pressure was 168/92 when this arrhythmia was recorded.
1. What is your diagnosis?
2. What is your evidence?
Submit your answer in the Entry Form below.
12-Lead ECG Grand Rounds Case #1 Answers submitted:
Case Number 1 above was Solved on May 10, 2021 by Jerry Hannibal, RN and will remain posted until May 20, 2021 - See Case #2 below.
The ECG above was recorded from a 65-year old woman with a five-year history of angina; she was admitted to the CCU with palpitations and chest pain with a blood pressure 168/92 at the time of this recording.
Here is Jerry's correct answer:
Atrial rate 375 - a little high for atrial flutter, though the regularity of the atrial waves suggests flutter.
Variable ventricular rate - on the slower side
PRI N/A
T-waves - obfuscated by underlying flutter
QTc of the "normal" beats cannot be calculated due to obfuscation of T-waves by flutter waves.
QRS of "normal" complex 0.08 seconds
Second beat in strip could be a fusion complex
The slick downstroke on the run of wide QRS complexes suggests intermittent left bundle branch block conduction. QRS of these complexes is 0.12, consistent with BBB.
So . . . Atrial fibrillation/flutter with slow ventricular response and intermittent LBBB aberrancy.
Here is Jonni Cooper's Answer:
Coarse Atrial Fibrillation or Atrial Flutter with varying A-V conduction and a 3-beat fun of LBBB aberration during 2:1 conduction, making the mechanism most likely Atrial Flutter.
Cooper's Rationale for left bundle branch block aberration rather than ventricular tachycardia is that in a V1 lead, there is a slick downstroke to an early nadir (less than 0.06 sec.) making this 99.5% likely to be left bundle branch block and not ventricular tachycardia. Many who tried the diagnosis opted for ventricular tachycardia because they have not learned Josephson's morphologic clues and therefore made the wrong diagnosis. And as for the underlying rhythm, the regularity of the Atrial waves makes this most likely atrial flutter with varying conduction. Anytime you see a long cycle followed by a short cycle, it may precipitate bundle branch block aberration or it may precipitate a ventricular rhythm and the only way to distinguish one from the other is by using lead V1 and looking closely at the morphologic clues given you. It would be great to have lead V6 for backup but even without it, the probability is high that this is a burst of LBBB aberration. For a lesson in bundle branch block see our Basic ECG Course module 2.
Case No. 2 - 12-Lead and Arrhythmia ECG Grand Rounds - Posted May 10, 2021
Case study number 2 was recorded from a 72 year old man with no symptoms. His blood pressure was 138/72. What is your diagnosis?
And what is your evidence?
Basic ECG Grand Rounds:
The Basic ECG Grand Rounds is a series of Basic level cases that we are now hosting free on the first and third Tuesdays of every month. They were designed for interaction among Cardiac Nurses, ECG and Monitor Technicians; other professionals are welcome to join in diagnosing.
Feel free to log in and learn from the cases and/or submit your diagnoses and thoughts.
How it Works:
We will post all answers submitted in the two week period so that participants can see what their colleagues are diagnosing. As soon as someone gets the most complete answer, we will post it along with our rationale below.
However, if no one gets the answer correct in the allotted time frame of 2 weeks, the answer along with our rationale will be provided.
Enjoy, and please provide your feedback whether you agree or disagree with the diagnoses we make. We can always provide references for our answers and welcome yours.
The Basic ECG Grand Rounds is a series of Basic level cases that we are now hosting free on the first and third Tuesdays of every month. They were designed for interaction among Cardiac Nurses, ECG and Monitor Technicians; other professionals are welcome to join in diagnosing.
Feel free to log in and learn from the cases and/or submit your diagnoses and thoughts.
How it Works:
We will post all answers submitted in the two week period so that participants can see what their colleagues are diagnosing. As soon as someone gets the most complete answer, we will post it along with our rationale below.
However, if no one gets the answer correct in the allotted time frame of 2 weeks, the answer along with our rationale will be provided.
Enjoy, and please provide your feedback whether you agree or disagree with the diagnoses we make. We can always provide references for our answers and welcome yours.
Case No. 1 - Basic ECG Grand Rounds - Posted May 10, 2021
This ECG was recorded from a 58 year old man with no presenting symptoms.
1. What is your diagnosis?
2. What is your evidence?
Submit your answer in the Entry Form below.
Basic ECG Grand Rounds Case #1 Answers submitted:
1. What is your diagnosis?
2. What is your evidence?
Submit your answer in the Entry Form below.
Basic ECG Grand Rounds Case #1 Answers submitted:
