Dr. Usman's Cardiology Notes

A 50 years old female with normal angiography and normal Echo ,with recurrent tachycardia, came to emergency in cardiac Hospital,patient reverted to sinus rhythm with sedation, lignocaine and magnesium sulphate,normal troponin and electrolytes ,Cardiac MR dome last year was also normal ,what should be best management plan for this ? What is the location of this tachycardia or VT? Is ablation possible for this patient as she doesn't tolerate this rhythm well? Few things seems to be eye catching but keeping in mind that surface ecg being only 12 leads has lots & lots of shortfalls for exact identification of endocardial source of arrhythmia ! Hence as you know , as the EP catheters are multipolars so much much more helpful in pin pointing the exact endocardial source of arrhythmias   1. The arrhythmias seem to be Ventricular driven  2. ⁠morphologically , it’s seems mono morphic rather than polymorphic , hence supporting a single focus  3. ⁠the shortest way to furt...

  Intracardiac Tracing 1 Intracardiac Tracing 2 In the first tracing, Surface ECG showing upright P waves in lead 1 , sinus rhythm, four complexes visible on the tracing, every p wave being followed by qrs, pre-excitation or delta wave is not evident Ablation catheter showing large negative unipolar deflection occuring before the onset of QRS. His catheter is likely more in the RV, His signal not visible, large V signals On CS earliest activation is at 7,8 and A and V signals are more close in CS 1,2 In the second tracing same findings but in the end of tracing atrial activation sequence is changed with 9,10 leading Conclusion: Likely diagnosis Left Sided concealed Pathway being ablated.

Interactive ECG Cases & Electrophysiology (EP) Traces explained in a simple and easy to understand way by Dr. Simon Fynn in a Cardiology Review Course. 👉 Watch other Educational Videos Here:   ✅ ECG Cases ✅ CATH Mock Exam ✅ Cardiovascular Board Review Lectures ✅ Trans-Thoracic Echocardiography Standard Protocol Step by Step ✅ Basics of Trans-Esophageal Echocardiogram ✅ ECHO Mock Exams ✅ Echocardiography Spot Diagnosis Case Series  

 A 40 year old man brought into the emergency room in a collapsed state with ECG given above. Carotid pulse was palpable (1+) and blood pressure was 80/45 mmHG. Thought 1: How to approach wide complex tachycardia? Thought 2: What is the first line drug in this case? This ECG has wide-complex tachycardia(QRS duration=120msec) at a rate of 180 bpm with a RBBB pattern, left superior axis deviation and R-S interval is hardly 80msec suggesting Idiopathic Fasicular Left Ventricular Tachycardia (ILVT) and due to left superior axis deviation its Posterior Fasicular VT . Right ventricular outflow tract tachycardia is also differential here but it is usually with LBBB morphology. During wide complex tachycardia the differentiation between supraventricular and ventricular origin of the arrhythmia is important to guide therapy. Several algorithms have been developed to aid in this differentiation which we will discuss in next sections. The patient was initially treated with success...