Question for January 7, 2013
Dr. Golding's "EKG of the Week"
Question for January 7, 2013
This 65yo patient on flecainide presented after 2 days of vomiting.
What is the rhythm disturbance here?
January 7 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