Tuesday, June 27, 2017

Timoptic (timinol) Induced Bradycardia

A 60 year old patient with a history of glaucoma, hypertension, and CHF.  The home meds were Betoptic (dorzolamide) BID, Timoptic (timinol) BID, Cozaar (losartan) qd, ASA qd, and Lasix (furosemide) BID.   The patient was admitted to the hospital with bradycardia, dizziness, and presyncopal episodes.  The cardiac enzymes were WNL.  An echo showed that the CHF was stable with a normal EF.  The cardiologist suggested that the bradycardia was a side effect of the Timoptic (Timinol) eye drops.  The monitor shows some extreme bradycardia with AV dissociation.









Sunday, June 25, 2017

Basic EKG Test 69

01. Identify the following rhythm.



02. Identify the following rhythm.

03. Identify the following rhythm.

04. Identify the following rhythm.

05. Identify the following rhythm.

06. Identify the following rhythm.

07. Identify the following rhythm.

08. Identify the following rhythm.

09. Identify the following rhythm.

10. Identify the following rhythm.

11 Identify the following rhythm.

12. Identify the following rhythm.

13. Identify the following rhythm.

14. Identify the following rhythm.

15. Identify the following rhythm.

16. Identify the following rhythm.

17. Identify the following rhythm.

18. Identify the following rhythm.

19. Identify the following rhythm.

20. Identify the following rhythm.

21. Identify the following rhythm.

22. Identify the following rhythm.

23. Identify the following rhythm.

24. Identify the following rhythm.

25. Identify the following rhythm.

Answers
01. Accelerated junctional rhythm
02. P wave asystole
03. Normal sinus rhythm
04. Ventricular fibrillation
05. Atrial fibrillation
06. Biventricular paced with a PVC
07. Second degree heart block type I
08. Sinus rhythm with a fusion beat
09. Sinus tachycardia
10. Second degree heart block type II
11. Atrial fibrillation with rapid ventricular response
12. AV paced
13. Third degree heart block
14. First degree block
15. Sinus arrhythmia with a pause
16. Sinus rhythm with a PAC
17. Sinus rhythm with a bigeminal PVCs
18. Supraventricular tachycardia
19. Ventricular paced
20. Ventricular tachycardia
21. Atrial flutter
22. Sinus bradycardia
23. Artifact
24. Demand ventricular pacing
25. Sinus rhythm with a PVC

Wednesday, June 21, 2017

Pacemaker Problems

This strips shows an AV paced rhythm.   After the 4th complex there is failure to capture.  The fifth complex show failure to sense.  The AV interval on the sixth complex is shorter than the previous paced beats.  Between the 7th and 8th complex there is failure to capture.  The 8th complex is a fusion complex.


Tuesday, June 20, 2017

Hyperkalemia with serum potassium of 7.5 mEq/L





Serum potassium > 7.0  mEq/L is associated with conduction abnormalities and bradycardia:
  • Prolonged QRS interval with bizarre QRS morphology
  • High-grade AV block with slow junctional and ventricular escape rhythms
  • Any kind of conduction block (bundle branch blocks, fascicular blocks)
  • Sinus bradycardia or slow AF
  • Development of a sine wave appearance (a pre-terminal rhythm)
From Life in the Fast Lane https://lifeinthefastlane.com/ecg-library/basics/hyperkalaemia/

Monday, June 19, 2017

Basic EKG Test 68

01. Identify the following rhythm.

a. Atrial fibrillation
b. Normal sinus rhythm
c. Artifact
d. Ventricular fibrillation

02. Identify the following rhythm.

a. Atrial flutter
b. Normal sinus rhythm
c. Sinus arrhythmia
d. Complete heart block

03. Identify the following rhythm.

a. Sinus bradycardia with an exit block
b. Junctional rhythm
c. Third degree heart block
d. Sinus rhythm with a dropped PAC

04. Identify the following rhythm.

a. Normal sinus rhythm
b. Junctional rhythm
c. Atrial fibrillation
d. Torsades de pointes

05. Identify the following rhythm.

a. Wenckebach
b. First degree block
c. Sinus rhythm with a pause
d. Atrial flutter

06. Identify the following rhythm.

a. Third degree heart block
b. Ventricular tachycardia
c. Sinus bradycardia with bigeminal PVCs
d. Sinus rhythm with multifocal PVCs

07. Identify the following rhythm.

a. Sinus bradycardia
b. Sinus arrhythmia
c. Sinus tachycardia
d. Normal sinus rhythm

08. Identify the following rhythm.

a. Supraventricular tachycardia
b. Sinus tachycardia
c. Atrial fibrillation with rapid ventricular response
d. Ventricular tachycardia

09. Identify the following rhythm.

a. Sinus bradycardia
b. Complete heart block
c. Junctional rhythm 
d. Agonal rhythm

10. Identify the following rhythm.

a. Atrial paced
b. Ventricular paced
c. AV paced
d. Biventricular paced

11 Identify the following rhythm.

a. Sinus arrhythmia
b. First degree heart block
c. Second degree heart block type I
d. Sinus rhythm with an exit block

12. Identify the following rhythm.

a. Sinus tachycardia
b. Ventricular tachycardia
c. Junctional tachycardia
d. Atrial fibrillation with rapid ventricular response

13. Identify the following rhythm.

a. Atrial fibrillation
b. Sinus bradycardia
c. Idioventricular rhythm
d. Junctional rhythm

14. Identify the following rhythm.

a. Normal sinus rhythm
b. Junctional tachycardia
c. Sinus tachycardia
d. Ventricular fibrillation

15. Identify the following rhythm.

a. Sinus arrhythmia
b. Normal sinus rhythm with a PJC
c. Sinus rhythm with a PAC
d. Sinus rhythm with a PVC

16. Identify the following rhythm.

a. Atrial fibrillation with slow ventricular response
b. Sinus bradycardia
c. Accelerated junctional rhythm
d. Agonal rhythm

17. Identify the following rhythm.

a. Sinus tachycardia
b. Sinus bradycardia
c. Sinus rhythm 
d. Sinus arrhythmia

18. Identify the following rhythm.

a. Accelerated idioventricular rhythm
b. Ventricular paced
c. Ventricular tachycardia
d. Normal sinus rhythm

19. Identify the following rhythm.

a. Normal sinus rhythm with unifocal PVCs
b. Accelerated junctional rhythm with unifocal PVCs
c. Atrial fibrillation with unifocal PVCs
d. Sinus tachycardia with unifocal PVCs

20. Identify the following rhythm.

a. Sinus rhythm with a PAC
b. First degree block with a PVC
c. Sinus tachycardia with a PJC
d. Sinus arrhythmia with a PAC

21. Identify the following rhythm.

a. Complete heart block
b. Idioventricular rhythm
c. Agonal rhythm
d. Sinus bradycardia

22. Identify the following rhythm.

a. Atrial flutter
b. Atrial fibrillation
c. Atrial tachycardia
d. Atrial paced

23. Identify the following rhythm.

a. Atrial fibrillation
b. Multifocal atrial tachycardia
c. Wandering atrial pacemaker
d. Atrial flutter

24. Identify the following rhythm.

a. Sinus arrhythmia
b. Sinus rhythm with a PJC
c. Sinus rhythm with a PVC
d. Sinus rhythm with a PAC

25. Identify the following rhythm.


a. Atrial paced with failure to sense
b. Biventricular paced with failure to pace
c. Dual paced with failure to understand
d. Ventricular paced with failure to capture


Answers
01. c. Artifact
02. d. Complete heart block
03. a. Sinus bradycardia with an exit block
04. b. Junctional rhythm
05. b. First degree block
06. c. Sinus bradycardia with bigeminal PVCs
07. b. Sinus arrhythmia
08. a. Supraventricular tachycardia
09. d. Agonal rhythm
10. d. Biventricular paced
11. c. Second degree heart block type I
12. d. Atrial fibrillation with rapid ventricular response
13. c. Idioventricular rhythm
14. d. Ventricular fibrillation
15. c. Sinus rhythm with a PAC
16. c. Accelerated junctional rhythm
17. a. Sinus tachycardia
18. a. Accelerated idioventricular rhythm
19. c. Atrial fibrillation with unifocal PVCs
20. c. Sinus tachycardia with a PJC
21. a. Complete heart block
22. a. Atrial flutter
23. b. Multifocal atrial tachycardia
24. a. Sinus arrhythmia
25. d. Ventricular paced with failure to capture