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Arms-Legs Reversal

Report:Sinus rhythm 60/min Legs-arms reversal Normal trace Comment:The pattern is diagnostic: retrograde P waves and flat L1. This is much less common than arms or V1 – V2 or V3 reversal. In this case the computer went for the arms reversal with “a

1o AV Block Expressing BBBB

Report: Sinus rhythm 77 – 82/min Left atrial abnormality (LAA) First degree AV block PR 0.22” Intermittent right bundle branch block + left anterior hemiblock PR 0.16” Nonspecific T wave changes Comment: At first, one would postulate a disso

QR in V6 in WPW Conduction

Report: Sinus rhythm 70/min Left axis deviation –50o Wolff-Parkinson-White conduction, type' A' Comment: The δ waves are relatively subtle and the computer reported "old inferior Mr' and "probable posterior wall involvement". This is a well-known ma

Sudden Death During Holter Monitoring

Report:Top: Sinus rhythm Dimorphic VEB couplet Middle: Deepening T wave inversion VEB R-on-T VEB following post-ectopic pause Ventricular tachycardia 187/min following R-on-T VEB Bottom (after carotid sinus massage): Ventricular tachycardia 212

Narrow VEBs & Trifascicular Block

Report:Sinus rhythm 85/min Second degree AV block, unspecified VEBs in bigeminy Right axis deviation +120o Left posterior hemiblock Right bundle branch block Comment:It’s best to observe the bigeminal VEBs in the rhythm strip: no two are the same.

Sotalol Arrhythmias

Report: Sinus rhythm Borderline first degree AV block PR 0.20” VEBs, frequent Runs (3-beat, 5-beat) of multiform ventricular tachycardia Incomplete LBBB Prolonged QT interval Comment: The patient’s torsades (Fig 130a) were treated by MgSO4, the

104. 88 year old patient with permanent pacemaker and ischæmic cardiomyopathy.

Fascicular VT with 1:1 Retrograde Conduction

Report:Ventricular tachycardia 106/min 1:1 retrograde conduction Comment:This is a very slow VT – well within what some authorities would call AIVR. It is fascicular, with the QRS complex only 0.12” long. Its morphology is that of basic RBBB/LAHB, o

Hypokalæmia

Report: Sinus rhythm Diffuse nonspecific ST/T changes Comment: The potassium level was 1.9. It is uncommon to see this degree of T wave inversion. The inverted T waves merge into the still upright U waves, resembling digoxin/quinidine combination of old

Slowing Rate with Battery Depletion

Report:Atrial fibrillation 1 Pacemaker rhythm 60/min 2 Possible battery depletion 7 Comment:Battery depletion is usually programmed to manifest itself by slowing to a pre-set rate, in this case 60/min. This patient’s potential problem was in fact dia