Interpret this - EKG...Monitor printout

1 week old, s/p Arterial Switch Operation. 6 hrs postop.
Clue: Arterial trace gives it away.

Narrow Complex Tachycardia/SVT - 3 types of responses to Adenosine

Response 1 - Adenosine terminates SVT to sinus rhythm
Response 2 - Adenosine terminates SVT to sinus rhythm; but, SVT returns
Response 3 - Adenosine decreases ventricular response, enabling the correct diagnosis of Atrial Flutter (This narrow complex tachycardia was not SVT)

Thus, if Adenosine does not treat it. It helps to uncover the correct diagnosis! It is important to record EKG strip during Adenosine administration so that the type of response can be carefully analyzed and documented.


EKG - Interpret this

8-day old, 31 week gestation baby. Recovering from Respiratory distress syndrome.
Consulted for episodes of bradycardia.


EKG: Dextrocardia

Panel 1: EKG recorded with standard lead placements
Panel 2: EKG recorded with reversed lead placement (Illustrates why this should not be done)

It is good exercise to compare the two EKGs and identify how reversing lead positions change the morphology of the complexes.


SVT - Onset & Termination from Holter recording

Is it SVT or AET?
Click on the image to enlarge.


EKG: PR interval

PR interval appears to be shorted after the ectopies. What is the mechanism?


Anatomy: Left Aortic Arch with Right Descending Aorta

Left Aortic Arch with Right Descending Aorta: Possible type
(From Esophagography in anomalies of the aortic arch system by A.C. Klinkhamer. 1969. Williams & Wilkins Company, Baltimore, MD)
See related posting


Vascular Ring - General Rules

From Moss & Adams(Vol. 1) 7th ed. 2008.
Chapter: Aortic Arch Anomalies by Dr. Paul Weinberg.

1) Arch sidedness: Retroesophageal or Isolated vessel always is the vessel on opposite side from the arch.

2) Vascular Ring: Easier to recognize the existence of vascular ring if all components of the ring are patent. The following rule is helpful when the ring is completed by an atretic ligament on one side i.e. Presence of one of the 3 Ds on the opposite side from the aortic arch indicates presence of a vascular ring. (3Ds are Diverticulum, Dimple or Descending aorta).