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176 RBBB + LAFB = bifascicular blockThe RBBB is diagnosed by the wide QRS with prominent anterior (e.g., V1) and late rightward (e.g., I, V6) forces. The LAFB is recognized by the marked left axis deviation (-75 degrees) in the frontal plane, rS complexes in II, III, aVF, and the tiny q-wave in aVL.Knowledge Weavers ECG
177 Massage parlor gamesWhen unsure of the mechanism of a supraventricular tachycardia, carotid sinus massage may help make the diagnosis. In this example, carotid sinus massage causes marked AV block which permits easy recognition of the rapid, regular atrial flutter waves.Knowledge Weavers ECG
178 Wandering baseline artifact - marquetteWandering baseline artifact - marquetteKnowledge Weavers ECG
179 Frontal plane QRS axis = +15 degreesFrontal plane QRS axis = +15 degreesKnowledge Weavers ECG
180 Frontal plane QRS axis = +30 degreesFrontal plane QRS axis = +30 degreesKnowledge Weavers ECG
181 Acute inferoposterior MIAcute inferoposterior MIKnowledge Weavers ECG
182 Sinus bradycardiaSinus bradycardiaKnowledge Weavers ECG
183 2nd degree AV block, mobitz type II, with LBBBThe wide QRS complexes in lead V1 indicates LBBB. 2nd degree AV block, Mobitz II is suggested by the two fixed PR intervals prior to the nonconducted P wave. The location of the block is most likely in the right bundle, because Mobitz II is usually a sign of bilateral bundle branch disease.Knowledge Weavers ECG
184 A very subtle atrial tachycardia with 2:1 blockAlthough at first glance this looks like normal sinus rhythm at 95 bpm. On closer look, there are 2 P waves for every QRS; the atrial rate is 190 bpm. Note the hidden P in the T waves. This rhythm is likely due to digitalis intoxication, as are the GI symptoms.Knowledge Weavers ECG
185 Left atrial enlargementLeft atrial enlargement is illustrated by increased P wave duration in lead II, top ECG, and by the prominent negative P terminal force in lead V1, bottom tracing.Knowledge Weavers ECG
186 Acute postero-lateral MI: precordial leadsAcute postero-lateral MI: precordial leadsKnowledge Weavers ECG
187 Pacemaker failure to pace - marquettePacemaker failure to pace - marquetteKnowledge Weavers ECG
188 Frontal plane QRS axis = 90 degreesFrontal plane QRS axis = 90 degreesKnowledge Weavers ECG
189 Junctional tachycardia - marquetteJunctional tachycardia - marquetteKnowledge Weavers ECG
190 Diagram: frontal plane leadsDiagram: frontal plane leadsKnowledge Weavers ECG
191 Inferoposterior MIInferoposterior MIKnowledge Weavers ECG
192 Digitalis intoxication: Junctional tachycardia with and without AV blockIn a patient with longstanding atrial fibrillation being treated with digoxin, a regular tachycardia, as seen in A, with a RBBB suggests a junctional or supraventricular tachycardia. Group beating, in B, is likely due to a 2nd degree, Type 1, exit block below the ectopic junctional focus. This is h...Knowledge Weavers ECG
193 Nonconducted PACs and junctional escapesAlthough at first glance this looks like 2nd degree AV block, the P waves indicated by the arrows are premature and not sinus P waves. The pause is long enough to encourage a junctional escape focus to take over. Note the sinus P waves just before the escape beats. Had the escapes not occurred, t...Knowledge Weavers ECG
194 WPW diagramThe short PR interval is due to a bypass track, also known as the Kent pathway. By bypassing the AV node the PR shortens. The delta wave represents early activation of the ventricles from the bypass tract. The fusion QRS is the result of two activation sequences, one from the bypass tract and one...Knowledge Weavers ECG
195 PVC with venticular echoThe PVC in this example retrogradely enters the AV junction and returns, usually down a different pathway, to reactivate the ventricles....a ventricular echo. This is unlikely to be an interpolated PVC because the PR interval following the PVC is too short for the sinus impulse to have entered the ...Knowledge Weavers ECG
196 Left bundle branch block (LBBB)LBBB is recognized by 1) QRS duration>0.12s; 2) monophasic R waves in I and V6; and 3) terminal QRS forces oriented leftwards and posterior. The ST-T waves should be oriented opposite to the terminal QRS forces.Knowledge Weavers ECG
197 Fatty acid elongation in mitochondriaThis shows the overall reaction of fatty acid elongation in mitochondria. The process is essentially a reversal of beta-oxidation, except that one NADPH and one NADH are required (beta-oxidation yields two NADH). Mitochondrial fatty acid elongation acts primarily on fatty acyl CoA substrates short...Knowledge Weavers Fatty Acids
198 PAC with RBBB aberrant conductionPAC with RBBB aberrant conductionKnowledge Weavers ECG
199 Interpolated PVCs - marquetteInterpolated PVCs - marquetteKnowledge Weavers ECG
200 PVC triplet - marquettePVC triplet - marquetteKnowledge Weavers ECG
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