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Clinical ECGs Part 1 – Contours
David J. Callans, MD, is a professor of medicine at the University of Pennsylvania and director of the Electrophysiology Laboratory at the Hospital of the University of Pennsylvania. Here, he presents several electrocardiograms involving arrhythmias, and invites his audience to interpret each of them before going on to his own interpretation and explanation. The lecture opens with a series of multiple choice questions based upon the ECG’s shown. Using 12 case studies and 60 illustrations, Dr. Callans explains step-by-step differential diagnoses involving supraventricular tachycardia (SVT), atrial fibrillation, and atrial flutter as well as several illustrations of ventricular tachycardia. Identifying the P wave and its morphology, he contends, is the hardest part of the differential diagnosis in the electrocardiograms he shows. Establishing a specific diagnosis of arrhythmia can be helped by carotid sinus massage. He illustrates the importance of P wave location relative to the QRS during SVT. Dr. Callans also describes the characteristics of atrial flutter, noting that the atrium is the ‘driver’ for arrhythmia, and that atrial fibrillation is often mistaken for atrial fluttter. The author shows a ‘bizarre’ ECG of atrial fibrillation in the setting of Wolf-Parkinson-White syndrome and explains the danger of atrial fibrillation in this setting. In a case study of morphologic clues, Dr. Callans poses – and answers -- multiple choice questions involving left bundle branch and right bundle branch type patterns in ventricular tachycardia. The lecture concludes with a discussion of Long QT syndrome, Torsade des Pointes and sinus node dysfunction. Using case studies, illustrations and multiple choice questions, the author provides an excellent example of participatory learning in CME. |
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