This is an autosomal dominant disease with variable penetration that is second only to HCM in causing sudden cardiac death in otherwise healthy young people. Dr. Burns presents basic ECG findings of ARVH as well as discussing other diagnostic studies and treatment. Highlights below.
What exactly are the electrical criteria for LVH? Dr. Burns walks us through it on LITFL. Not a copa cardiogram, this one's on the house!
Dr. Mattu reminds us of our differential for really wide QRS complexes, also quick approach to TCA overdose treatment.
This week take a chance to walk step by step through an initially complex appearing EKG. Dr. Mattu shows how a step by step approach, stopping at each abnormality found to analyze the differential. A reminder of his systematic approach: Click the Read More link to see some of the diferentials discussed this week.
Dr. Mattu walks us through how to read an abnormal appear ECG and not miss the subtle MI. He recommends a logical, stepwise approach. By considering the differential of each abnormality seen you can begin to understand what is happening with the pt's heart. Finally, apply the filter of your final diagnosis and look for the subtle clues to ischemia.
1) Rate and Rhythm
Some differentials worth reviewing noted below.
Key definition: LAFB + RBBB = Bifascicular block
2 criteria for low voltage:
1) QRS complex in I+II+III <15 mm
- or -
2) QRS complex in V1+2+3 <30 mm
Low voltage is either a 'weak battery' or there is something dampening the current reaching your leads.
Intrinsic low voltage:
- Infiltrative disease
- End stage cardiomyopathy
- Severe hypothyroidism
- Pericardial effusion
- Pleural effusion
If the low voltage is new, consider new onset severe hypothyroidism, pericardial or pleural effusions.
Dr. Mattu urges us to make life more simple. Forget the complex algorithms for Wide Complex Tachycardias and keep it simple.
BLUF: Wide complex tachycardia should be treated as VTACH
1) If obviously, without question is sinus tach with aberrancy, then treat underlying cause. If any amount of doubt exist...
2) Treat it as VTACH
Our thanks to Dr. Tim Davie for assembling the Copa Cardiogram each week. Please follow this link to get to spreadsheet of all Copa Cardiograms.
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