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151 PAC's with and without aberrant conduction - marquettePAC's with and without aberrant conduction - marquetteKnowledge Weavers ECG
152 Hydroxymethylglutaryl CoA synthase reactionThis irreversible reaction occurs in the mitochondria, where it is the first step in ketone body synthesis. It also occurs in the cytoplasm, where it leads to isoprenoid and steroid synthesis.BiosynthesisKnowledge Weavers Fatty Acids
153 Ventricular fibrillation - marquetteVentricular fibrillation - marquetteKnowledge Weavers ECG
154 Nonconducted PAC - marquetteNonconducted PAC - marquetteKnowledge Weavers ECG
155 Thiolase reactionThiolase (3-ketoacyl CoA thiolase) cleaves a long chain fatty acyl CoA, forming acetyl CoA and a long chain fatty acyl CoA that is two carbons shorter.Knowledge Weavers Fatty Acids
156 Trifascicular block: RBBB, LAFB, and mobitz II 2nd degree AV blockA nice example of trifascicular block: Lead V1 shows RBBB; Lead II is mostly negative with an rS morphology suggesting left anterior fascicular block. Since Mobitz II 2nd degree AV block is more often located in the bundle branch system, the only location left for this block is the left posterior ...Knowledge Weavers ECG
157 2nd degree AV block, type I, with junctional escapesJunctional escapes are passive, protective events whenever the heart rate slows below that of the escape mechanism. In this example of 2nd degree AV block, type I, the escapes occur following the non-conducted P waves. Arrows indicate the position of the P waves. Note that the escape beats have a...Knowledge Weavers ECG
158 Atrial flutter with 2:1 AV conductionAtrial flutter with 2:1 AV block is one of the most frequently missed ECG rhythm diagnoses because the flutter waves are often hard to find. In this example two flutter waves for each QRS are best seen in lead III and V1. The ventricular rate at 150 bpm should always prompt us to consider atrial fl...Knowledge Weavers ECG
159 Identification of PVC's and PAC'sPVC's usually stick out like sore thumbs; PAC's are often difficult to see because they are hidden in the preceding ST-T wave. The PVC in this example is mostly negative in lead V1 suggesting RV origin; i.e., most of activation is moving in posterior direction towards the left ventricle.Knowledge Weavers ECG
160 AV dissociation by defaultThe nonconducted PAC's set up a long pause which is terminated by ventricular escapes; note the wider QRS morphology of the escape beats indicating their ventricular origin. Incomplete AV dissociation occurs during the escape beats, since the atria are still under the control of the sinus node.Knowledge Weavers ECG
161 Lead error: V1 and V3 are transposed!In the precordial leads the V1 and V3 chest electrodes are interchanged. Experienced ECG interpreters should be able to spot this lead placement error.Knowledge Weavers ECG
162 Infero-posterior MI & RBBB: Frontal Plane Leads + V1Infero-posterior MI & RBBB: Frontal Plane Leads + V1Knowledge Weavers ECG
163 WPW Type Pre-excitation: Precordial LeadsWPW Type Pre-excitation: Precordial LeadsKnowledge Weavers ECG
164 Acute anterior MIAcute anterior MIKnowledge Weavers ECG
165 2nd degree AV block, type I with escapes and capturesOften in the setting of 2nd degree AV block the pauses caused by nonconducted P waves are long enough to enable escape pacemakers from the junction or ventricles to take over. This example illustrates junctional escapes, labled E and captures, labled C. Note that the PR intervals for the captures ...Knowledge Weavers ECG
166 Ventricular paced rhythm with retrograde wenckebachRetrograde atrial captures from a ventricular paced rhythm are occurring with increasing R-P intervals; i.e., retrograde Wenckebach. The ladder diagram indicates that after the blocked retrograde event, a single sinus P wave is seen dissociated from the ventricular rhythm.Wenckebach AV BlockKnowledge Weavers ECG
167 Nonconducted PAC's: an unusual bigeminyOccasionally nonconducted PAC's can create interesting rhythms. In this example every other sinus beat is followed by an early, nonconducted PAC. The resulting pause sets up a bigeminal rhythm. Note the distortion of the T waves caused by the nonconducted PAC's.Knowledge Weavers ECG
168 Atrial flutter with 2:1 AV conduction: leads II, III, V1In leads II and III, the one of the flutter waves occurs at the end of the QRS complex and might be mistaken for part of the QRS itself; i.e., the S wave. In lead V1, the two flutter waves for every QRS are more easily identified.Knowledge Weavers ECG
169 Accelerated IVR with AV dissociation - marquetteAccelerated IVR with AV dissociation - marquetteKnowledge Weavers ECG
170 Old inferior MIOld inferior MIKnowledge Weavers ECG
171 Beta-oxidation of a delta-9 fatty acyl CoAEnoyl CoA isomerase is required to move the double bond in a Delta-9 fatty acyl CoA to a position where it can continue in beta-oxidation.Knowledge Weavers Fatty Acids
172 Thiolase reaction with acetoacetyl CoAThiolase (3-ketoacyl CoA thiolase) cleaves acetoacetyl CoA, forming two molecules of acetyl CoA.Knowledge Weavers Fatty Acids
173 Stearic acid structureStearic acid is a typical long chain saturated fatty acid.Knowledge Weavers Fatty Acids
174 Diagram: type I vs. type II 2nd degree AV blockIn type I 2nd degree AV block the PR progressively lengthens until a nonconducted P wave occurs. The PR gets longer by smaller and smaller increments; this results in gradual shortening of the RR intervals. The RR interval of the pause is usually less than the two preceding RR intervals. The RR i...Knowledge Weavers ECG
175 PAC's with RBBB aberrationThese PAC's, indicated by arrows, enter the ventricles and find the right bundle refractory. They therefore conduct with RBBB aberrancy. In most normal hearts the right bundle recovery time is longer than the left bundle's; most aberrancy, therefore, has aRBBB morphology. In some diseased hearts t...Knowledge Weavers ECG
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