Table Of ContentPodrid’s Real-World
A Master’s Approach
to the Art and Practice
of Clinical ECG Interpretation
Narrow and Wide Complex
Volume 5 Part B: Practice Cases
Tachyarrhythmias and Aberration
Philip Podrid, MD Rajeev Malhotra, MD, MS
Rahul Kakkar, MD Peter A. Noseworthy, MD
Podrid’s Real-World ECGs
A Master’s Approach to the Art and Practice of Clinical ECG Interpretation
Volume 5
Narrow and Wide Complex Tachyarrhythmias and Aberration—Part B: Practice Cases
Philip Podrid, MD Rahul Kakkar, MD
Professor of Medicine Massachusetts General Hospital
Professor of Pharmacology and Experimental Therapeutics Harvard Medical School
Boston University School of Medicine Boston, Massachusetts
Lecturer in Medicine
Harvard Medical School Peter A. Noseworthy, MD
Boston, Massachusetts Massachusetts General Hospital
Attending Physician Harvard Medical School
West Roxbury VA Hospital Boston, Massachusetts
West Roxbury, Massachusetts
Rajeev Malhotra, MD, MS
Instructor in Medicine
Cardiology Division
Massachusetts General Hospital
Harvard Medical School
Boston, Massachusetts
Minneapolis, Minnesota
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Podrid’s Real-World ECGs—The Complete Series
Podrid’s Real-World ECGs: A Master’s Approach to the Art and Practice of Clinical ECG Interpretation
Volume 1 The Basics
Volume 2 Myocardial Abnormalities
Volume 3 Conduction Abnormalities
Volume 4 Arrhythmias
Part A: Core Cases
Part B: Practice Cases
Volume 5 Narrow and Wide Complex Tachyarrhythmias and Aberration
Part A: Core Cases (with introductory text)
Part B: Practice Cases
Volume 6 Paced Rhythms, Congenital Abnormalities,
Electrolyte Disturbances, and More
For more information about the other volumes in the series, please visit cardiotextpublishing.com
Practice Cases
PPrraaccttiiccee CCaassee X62X
Am an is brought to the emergency department having been found
unconscious. Prior to his arrival, the emergency medical
technicians faxed a 12-lead ECG to you (ECG 62A). The history they
relay on route is that of a 68-year-old man with a history of a remote
myocardial infarction who was found by his family unconscious on the
floor of his apartment. He had been well the morning of presentation.
ECG 62A
22
PPrraaccttiiccee CCaassee X6X2
He was treated in the field based on the ECG provided. Initial What is your interpretation of his initial ECG?
vital signs were notable for a tachycardia and hypotension, and after
What arrhythmia diagnosis is suggested?
appropriate therapy, his vital signs stabilized. He was intubated
prior to arrival.
What clinical diagnosis is suggested in
Upon admission to the emergency department, a repeat ECG is
comparing the two tracings?
obtained (ECG 62B).
ECG 62B
33
Podrid’s Real-World ECGs
^ ^ ^ ^ ^
ECG 62A Analysis: Ventricular tachycardia (sustained monomorphic)
4
Narrow and Wide Complex Tachyarrhythmias and Aberration—Part B: Practice Case 62
ECG 62A shows a regular rhythm at a rate of 220 bpm. The QRS uniform, as the activation of the ventricle follows the same pathway
complex duration is increased (0.18 sec), and the morphology is not each time. Thus, every QRS complex and ST-T wave is the same. In
typical for either a right or left bundle branch block. Although there ventricular tachycardia, the activation of the left ventricle is not
are no obvious P waves seen, there are inconsistent abnormalities of using the normal His-Purkinje system, but rather an alternative
the ST-T waves, best seen in leads I ((cid:2)) and V1 ((cid:3)). The variability in pathway that results in direct ventricular activation. The activation
the ST-T waves may be due to superimposed P waves or may be differ- sequence may be variable, accounting for differences in the QRS com-
ences in repolarization. There is also variability in the QRS complex plex. The abnormalities in ventricular depolarization is associated
morphology seen in lead V1 ((cid:2092)). Such variability is not seen in a supra- with abnormalities in ventricular repolarization, accounting for the
ventricular tachycardia in which depolarization and repolarization are ST-T wave changes.
continues
5
Podrid’s Real-World ECGs
+
+
(cid:2)
+
(cid:2) +
^
+
+
+ (cid:2)
+ ^
+ +
+
+
ECG 62B Analysis: Normal sinus rhythm, right atrial hypertrophy (abnormality),
first-degree AV block (prolonged AV conduction), old lateral and anteroapical
myocardial infarction, left ventricular aneurysm, low voltage in limb leads
6
Description:60 Practice Cases.
