Dr. Golding's "EKG of the Week" Question for January 30, 2012

This 65yo patient on flecainide presented after 2 days of vomiting.
What is the rhythm disturbance here?

January 30 EKG

  ANSWER     

Residents: The "EKG of the Week" is an exercise to review essential EKG skills for family physicians. These EKG's form the basis of the test EKG's we are using to assess EKG competence. There is general agreement that both office-based and hospital-based physicians should be comfortable evaluating EKG's for the presence of the below conditions (a partial list, not intended to suggest mastery of below ensures overall competence.)

Although the quiz may ask you to focus on one particular aspect of an EKG or rhythm strip, it is worthwhile to make sure you examine the whole cardiogram. On the test, you will be asked to do a complete reading on some EKG's.

This series does not address such basics as how to determine rate, axis, or how to measure intervals. Contact me (JG) if you need help with this!

Conditions/Competency skills required:.

Recognition of myocardial infarction and reciprocal changes

Determining age/acuity of MI using ST segment and Q wave cues

Determining localization of infarction using regional lead patterns: anterior, inferior, lateral, posterior, subendocardial

Evaluating for patterns suggestive of ischemia - T wave abnormalities and ST segment abnormalities

Bundle branch block - presence and type (left, right, indeterminate), and awareness of patterns of ischemia with underlying BBB

Recognition of left anterior fascicular block, in isolation and in presence of RBBB

Chamber enlargement: LVH and associated reploarization changes; findings suggestive of RVH and pulmonary hypertension; right and left atrial enlargement

Pericarditis

Normal ST-T wave variants (like early repolarization), and pathologic Tw changes such as hyperkalemia

Dysrhythmias: Ventricular tachycardia and fibrillation, 2nd degree heart block types I and II, 3rd degree heart block, atrial fibrillation and atrial flutter, supraventricular tachycardias, simple PVC's and PAC's