Thursday, September 29, 2016

Failure to Capture Part II

The patient was becoming cyanotic.  He did not have a palpable pulse.  By the time we could get BP machine to the room, the episode had passed.  He was noted to have his cell phone lying over his ICD/pacemaker so there is a question that the episode may have been induced by the cell phone.  The pacemaker was interrogated. 


 

Wednesday, September 28, 2016

Monday, September 19, 2016

MVP Mode Pacemaker

We recently had a patient with an AV pacemaker that appeared to have periods of failure to pace.





The pacemaker representative evaluated the rhythm and said that the pacemaker appeared to be set in the "MVP" mode.  The MVP mode works in the manner describe in this diagram

 
 



 

Saturday, September 17, 2016

Atrial fibrillation with slow ventricular response


Atrial fibrillation with slow ventricular response.  In the V1 lead it looks more like an atrial flutter.  The conduction through the AV node is variable and slow. 

 

Wednesday, September 14, 2016

Sinus bradycardia with an AV dissociation

 
Sinus bradycardia with an AV dissociation.  Notice the shortening PR interval on the 3rd - 6th complexes.  
 
 

 

 
 

Tuesday, September 13, 2016

Junctional escape beats

A dropped PAC is seen after the 2nd complex.  This is followed by three junctional escape beats.  A PAC occurs (6th complex) and another junctional escape beat is seen (7th complex)

 

Monday, September 12, 2016

Complete heart block.

Complete heart block.  The rhythm is irregular.  The QRS complexes are narrow too.  This suggests that the block is higher in the ventricle.  The rate is faster too. 

 

Sunday, September 11, 2016

Multifocal atrial tachycardia

Multifocal atrial tachycardia.  There are at least 3 different looking P waves throughout the strip.  A fusion beat is seen on the 2nd to the last complex. 

 

Saturday, September 10, 2016

Sinus rhythm changing to accelerated idioventricular rhythm

Sinus rhythm changing to accelerated idioventricular rhythm.  In lead II there appear to be some retrograde P waves that are following the QRS complexes. 

 

Friday, September 9, 2016

Ventricular paced with some fusion complexes

Ventricular paced with some fusion complexes.  The 3rd, 9th, and 10th complexes are the fusion complexes. 

 

Thursday, September 8, 2016

Paroxysmal atrial tachycardia

Paroxysmal atrial tachycardia.  Notice the change in the morphology of the P waves as the rhythm transitions back into a sinus rhythm.

 

Wednesday, September 7, 2016

Arterial blood pressure waveform

Sinus tachycardia.  This patient had an arterial line and a CVP.  The square wave test was done on the arterial line to evaluate the system dynamics.  Two to three oscillations should follow a fast flush of the system. 

 

Tuesday, September 6, 2016

Monday, September 5, 2016

Sinus rhythm changing to accelerated idioventricular rhythm

Sinus rhythm changing to accelerated idioventricular rhythm (AIVR).  The second page is a continuation of the first page. 


 

Saturday, September 3, 2016

Movement artifact

Movement artifact.  The omplexes are organized with artifact in between the complexes in leads I and V1.