EKG - Quiz

5-mo old, VSD closure, Repair of primum ASD and Cleft Mitral Valve. Postop. Day 4. H/O Junctional Ectopic Tachycardia - controlled with Amiodarone for the 2 days.
What is the rhythm?
What is the differential diagnosis?
How would you differentiate between Junctional Rhythm from Sinus rhythm with First degree AV block?
(Click on the image to enlarge)

Atrial lead is in V1.

A-paced at 150 bpm.


EP: Quiz, Interpret this EKG recording

You are called to consult for irregular heart rate. A newborn who has recovered from severe sepsis was noted to have irregular heart rate on the day of discharge. Therefore, discharge was canceled and you were consulted. A PICC line was removed the day before. Baby is otherwise doing well. Here are the traces. There are no answers for these traces. Your differential diagnosis and discussion is what is expected.


Quiz: EP - Apparent Malfunction of Pacemaker

1 yr old boy, s/p Mitral Valve replacement, Postop. AV block. Epicardial DDD pacemaker. HR range is set at 110-180 bpm.
First panel (24-hr trend) shows pacemaker heart rate decreased to ~110 bpm between 6pm & 10pm, when the patient was febrile.
Second panel shows EKG prior to drop in HR.
Third panel shows EKG during the low HR at ~110 bpm (with fever).
Fourth panel shows EKG after return of HR to higher level (after fever).
Fifth panel shows current EKG at the time of review (next day).

1) What are the possible reasons for the pacemaker not to respond appropriately during a time of need (fever)?
2) What further information is needed regarding pacemaker settings to determine the cause of this pacemaker behavior?
3) What change, if any need to be made in the pacemaker settings?


Wire shape for RPA and LPA

Image from Jim Lock's Cath Book 1987
(Diagnostic and Interventional Catheterization in Congenital Heart Disease.
James E. Lock, John F. Keane, Kenneth E. Fellows First edition 1987. Marinus Nijhoff Publishing, Boston, MA)

My first choice for LPA is just not to put any curves in the wire. But, you may need these wire shapes to enter "postop. LPAs".


Classification of Sports

36th Bethesda Conference
JACC 2005;45:1368-9