ECG quiz #1 + answer

Re: ECG quiz #1

Martin Atkinson — Tue, 14 Jan 2014 14:17:01 GMT

[quote user="Anthony Todd"]

I can see how you passed exams.

[/quote]Actually in my first year at Liverpool despite not being the most diligent reviser I got a distinction in anatomy with nigh on 100% because according to the professor I gave answers to the questions even they hadn't thought about. This had a detrimental effect upon my next year as I thought that if it was this easy I must be a real smarty-pants and perhaps did not do as much work as I might so it came back to bite me and I failed physiology (re-sit as well). Normally this would mean I was out but the fact I had Brucellosis was taken into consideration and they allowed me back to re-sit the year. I have to say that if I'd take as much interest in work as I did in girls, beer and sport (not necessarily in that order) the undulant fever may not have been the deciding factor. I realised after that that even I had to do some work!!

[quote user="Anthony Todd"]Geez, not only has he had more injuries than a premier league footballer, but he's got a bloody heart condition as well. He should be donated to medical science now!![/quote] I quite agree it even amazes me how well I recover from the injuries I inflict upon myself it certainly amazes my surgeons and physios.

Atko modest to a fault as ever.

Re: ECG quiz #1

Anthony Todd — Mon, 13 Jan 2014 19:18:19 GMT

[quote user="Martin Atkinson"] You don't get marks for answering questions that weren't asked. [/quote]

Mmmm,

I can see how you passed exams.

Why not let the organ-grinder answer?

Geez, not only has he had more injuries than a premier league footballer, but he's got a bloody heart condition as well. He should be donated to medical science now!!

Re: ECG quiz #1

Robin Grimmer — Mon, 13 Jan 2014 16:53:02 GMT

let's have another!

Re: ECG quiz #1

Martin Atkinson — Mon, 13 Jan 2014 14:15:06 GMT

[quote user="Anthony Todd"]

What about a comment on my S-T junction shift, my brilliant [IMHO] diagnosis of a possible myocarditis and the question of SGOT or PT or whatever the great and the good have decided to call the enzymes now...

[/quote] However brilliant the diagnosis may (or may not) be Anthony, you were only asked for rate, rhythm and abnormality! You don't get marks for answering questions that weren't asked.

That could be a trace of my heart as I suffer from palpitations and AFAIA (and I've had several ECG's) there is no underlying pathology, just strerss, caffeine and alcohol. But on the other hand there could be myocardial disease but one VPC does not make a summer!! The (relatively) small and variable P wave bother me slightly still though.

Re: ECG quiz #1

Anthony Todd — Mon, 13 Jan 2014 12:25:36 GMT

Re: ECG quiz #1

Martin Atkinson — Mon, 13 Jan 2014 12:22:21 GMT

[quote user="Mike Martin"]Heart rate is "per minute", but there is not a minute of tracing here to determine that. So an "estimate" of the rate can be given by counting the first 3 seconds. There are 5 sinus beats in the first 3 seconds which equates to a rate of 100/min. I'm really not too worried about being over exact on the rate and the heart rate naturally varies all the time anyway, so a rate anywhere from 80-110/min would probably get a mark from me. [/quote] I tried to be clever and measured it from the screen with a heart rate calculator ruler and it varied from 70-75 bpm so can I have a mark for that - pleeeze!

Re: ECG quiz #1

Michael Woodhouse — Mon, 13 Jan 2014 12:15:21 GMT

Ok you win!

Thanks Mike

Re: ECG quiz #1

Mike Martin — Mon, 13 Jan 2014 12:05:23 GMT

[quote user="Michael Woodhouse"] VPCs were wider than a normal complex and bizarre.[/quote]

Well it is. But maybe not as wide as average and there is a lot of variation too. But the fact it is different to the normal QRS makes it 'bizarre'.

The normal QRS duration is ~0.05sec and the VPC's QRS is ~0.08sec. But I'd rather people did not get into the detail of measurement for these things, as I feel it is not needed. Just see the VPC's QRS as different to the normal one. Hope this helps a bit?

Re: ECG quiz #1

Michael Woodhouse — Mon, 13 Jan 2014 10:31:11 GMT

Mike - thank you for the answers.

I do enjoy these, I personally would like more.

I find myself a little disappointed that the 6th complex is a VPC as I recall (strangely vividly) highlighting in my notes that VPCs were wider than a normal complex and bizarre.

Re: ECG quiz #1

Francisco Gomez — Mon, 13 Jan 2014 10:29:34 GMT

[quote user="Mike Martin"]

Let me know if you would like another ECG?

[/quote]

YES!

Re: ECG quiz #1

Mike Martin — Mon, 13 Jan 2014 10:26:43 GMT

Thanks everyone for participating, all a bit of fun but hopefully you enjoyed it.

The "exam-style" answer would be: There is an underlying sinus arrhythmia at 90-100/min with one ventricular premature complex (VPC).

Comments below the ECG here.

So a mark for each of the follow points:

The underlying rhythm is sinus in origin: with each P wave leading to a QRS and T - so a sinus rhythm.
The sinus rhythm has a degree of variation in the rate - so a sinus arrhythmia.
The 6th complex: the QRS morphology is different to the normal one coming down through the AV node - so it is bizarre: and hence it is a ventricular ectopic.
The ventricular ectopic is early in timing, ie. premature, so it is a ventricular premature complex (VPC).
Heart rate is "per minute", but there is not a minute of tracing here to determine that. So an "estimate" of the rate can be given by counting the first 3 seconds. There are 5 sinus beats in the first 3 seconds which equates to a rate of 100/min. I'm really not too worried about being over exact on the rate and the heart rate naturally varies all the time anyway, so a rate anywhere from 80-110/min would probably get a mark from me.

If you had said it was an atrial or supraventricular premature beat - give yourself 1 mark for the premature bit.

It was not quite fast enough to be R-on-T - so no bonus mark for that.

Let me know if you would like another ECG?

Re: ECG quiz #1

Anthony Todd — Fri, 10 Jan 2014 13:25:15 GMT

When do we get the criticisms, comments, and castigations??

Re: ECG quiz #1

ptveuk — Thu, 09 Jan 2014 16:45:07 GMT

I'm going with sinus arrythmia, 96 bpm with a single VPC( abnormal QRS suggests ventricular in origin and premature so not an escape beat). Could be wrong of course......

Re: ECG quiz #1

mariette asselbergs — Thu, 09 Jan 2014 16:11:36 GMT

I now realise that every thck line is 5 mm apart, not 10, so yes heart rate about 100.

Mariette

Re: ECG quiz #1

mariette asselbergs — Thu, 09 Jan 2014 15:56:21 GMT

Heart rate:To me it looks like there are 9x25mm in the posted ECG with 7 heartbeats. This would mean a rate of 49/minute. (not counting the extra one).

Mariette

Re: ECG quiz #1

Anthony Todd — Thu, 09 Jan 2014 15:22:11 GMT

Nah, I wanted a reply from the organ-grinder.....

Re: ECG quiz #1

Charlotte Marshall — Thu, 09 Jan 2014 15:18:46 GMT

I should know the answer as I did attend the course once! And it was very good, but it was quite a few years ago now and I'm not doing ECGs every day

Re: ECG quiz #1

Anthony Todd — Thu, 09 Jan 2014 15:04:54 GMT

[quote user="Charlotte Marshall"]why it is negative.[/quote]

I always thought that was because the electrical polarisation/depolarisation was happening in a different order because the heart muscle was contracting in a different way ie from a different origin and via a different path?

Do we have to attend the course to get the answers? [even though I probably should....]

Re: ECG quiz #1

Charlotte Marshall — Thu, 09 Jan 2014 14:55:21 GMT

I don't think that is a p wave associated with the abnormal beat is it? surely it is the T wave from the preceeding normal beat. I vote for sinus arrhythmia with one supraventricular ectopic but unsure why it is negative.

Re: ECG quiz #1

Martin Atkinson — Thu, 09 Jan 2014 14:40:30 GMT

[quote user="Robin Grimmer"]

It's not a VPC - it's not wide and bizarre and follows a P wave and there is a T wave after it. It is to all intents a normal QRS complex, just upside down. Ventricular bigemini? - prepares to be shot down in flames!

[/quote] IMO this is still a VPC, in ventricular bigeminy a VPC occurs after every normal QRS, its not a diagnosis in itself just the rate at which the VPC's occur.

Re: ECG quiz #1

Robin Grimmer — Thu, 09 Jan 2014 11:44:28 GMT

Re: ECG quiz #1

ChrisBVSc — Thu, 09 Jan 2014 11:14:52 GMT

I'm also going with rate around 90 and a VPC. Don't end up doing many ECGs so would be interested to know the 'official' answer!

Re: ECG quiz #1

Hannah Wynne Richards — Thu, 09 Jan 2014 09:23:19 GMT

PS I'm with those who think ventricular in origin

Wynne

Re: ECG quiz #1

Hannah Wynne Richards — Thu, 09 Jan 2014 09:20:17 GMT

Deflection negative because point of origine means wave of contraction going in opposite direction from 1 originating at node.

Wynne

Re: ECG quiz #1

James Laidlaw — Thu, 09 Jan 2014 08:12:17 GMT

Don't know how I got the rate so wrong. Busy day - is that an excuse? Definitely about 90 for rate (3 beats over 2 seconds)