Please Scroll Down to See Forums Below bor, ive got some questions for you.
BrothaBill.
- Thread starter juiceddreadlocks
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BrothaBill
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Shoot, nothing too personal though, best to use PMs for that.
what is the most detailed arrhythmia one can decipher using a 2 lead setup?
(assume left arm and right arm, modified leads)
(assume left arm and right arm, modified leads)
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BrothaBill
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juicedpigtails said:
Well, we usually use a three lead hookup as the most basic, I assume thats what you mean as one is a ground. So two is a positive and negative and right arm left arm is a called a modified lead one on the Einthovens triange.
It still can be used but the lead II configuration, one on the right shoulder and one on the left lower abdomen is more in plane with the way the heart depolarizes so the waves are more amplified making it easier to read. If the machinery you are using is good you should have minimal problems with a modified lead one.
As for reading of arrhythmias, again if the machine is adequate, I can read virtually all common arrhythmias with it. A 12 lead EKG separates out each lead individually so it doesnt matter how many leads you have. For basic arrhythmias, one needs to look at one lead hookup ergo your two lead setup would be able to distinguish them like afib, aflutter, vtac, vflutter, vfib. It wont be able to give you axis deviations, myocardial infarction and it might be hard to look for evidence of heart enlargement etc... But arrhythmias, I dont see that it would be that hard to distinguish if the amplitude of the waves was enought to define the pqrst waves.
actually it is really only 2 leads.
Right arm = positive
left arm = negative
the hardest so far to distinguish is what one would call a-fib from a-flutter. I realize one is considered a deadly rhythm and one not, correct?
Starting with tonight's patients i will attempt to use a setup with right arm and left abdomen instead of just right arm left arm.
Right arm = positive
left arm = negative
the hardest so far to distinguish is what one would call a-fib from a-flutter. I realize one is considered a deadly rhythm and one not, correct?
Starting with tonight's patients i will attempt to use a setup with right arm and left abdomen instead of just right arm left arm.
BrothaBill said:
excellent. can define pqrst waves.
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BrothaBill
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juicedpigtails said:
Yup, if you can define the pqrst then thats all you need. The first thing I look at is the lead II on an EKG, which is only two leads and define the rhythm first, its in usually sinus. The p depolarization tells you if you have atrial problems and its distance from the QRS complex and if its a regular interval and if its present. The QRS interval rate, form and shape and regularity i.e that it is not changing from beat to beat, tells me whats going on in the left ventricle. Those two pieces of info. pretty much provides for most arrythmias. I can tell them at a glance now b/c I recognize the patterns, but then I always go them by checklist of rate and regularity spacing etc...
Why, what are you using it for? Just sleep studies?
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BrothaBill
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juicedpigtails said:
In a fib there are multiple lil p waves if any that are detectable, the aflutter which isnt nearly as common, in fact, its very rare that Ive seen and has more definable pwaves. The QRS intervals are not in sync meaning the distance between each left ventricular depolarization changes from beat to beat since the av node delay lets in just a few on the hundreds of atrial depolarizations. The distinctions between afib and aflutter is not important as the av node prevents the massive number of electrical signals from reaching the ventricle, again assuming that they dont have wolff parkinson white syndrome which you can tell by lack of a downward deflection q wave and an upsloping towards the R, not common. So basically the ventricular rate is fine, although in afib there is controlled and uncontrolled ventricle rate, controlled less than 100 ventricular contractions and uncontrolled like 100-200 vcontractions and the patient has low blood pressure and is weak and lightheaded.
Atrial arrhythmias are for the most part not dangerous and I see afib patients every day as they are chronic with it. The only thing is that since the atriums dont contract well clot formation can occur and we keep them on coumadin.
You might be confusing aflutter with vflutter. Ventricular arrhythmias are dangerous and Vflutter leads to vfib as the muscle gets fatigued and build up of waste and other issues.
if what you say about how common a flutter isnt, then thats probably why ive been having trouble defining it. I have a basic understanding of arrhythmias and effects of ionotropic drugs and stuff. Basically everything from the first 160 pages of Dubin, i think i have a handle on. Ive never seen EKG as run on a tele machine or what you would do for a patient. I was really just wondering the difference in what you see and what i look at onscreen.
I've attempted to grasp everything youve thrown at me, but probably will require some review when i get a free second to get the books back out.
I've attempted to grasp everything youve thrown at me, but probably will require some review when i get a free second to get the books back out.
come on now, im not that much of an idiot.BrothaBill said:
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BrothaBill
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Atrial flutter is an infrequent arrhythmia generally found only in patients with significant heart disease where it is often associated with severe congestive heart failure, chest pain, or cerebrovascular sumptoms. The EKG often shows a typical 'sawtooth' (classic description) pattern which is often diagnostic in itself, particularly the atrial rate is 250-300 per minute. Almost invariable, an AV block of some type is present, and the vrate is usually 140-160 per minute.
The a rate of a fib is 400-800 per minute and the amount of the a rate is what typically distinguishes the two. Afib can occur in people for lots of reasons including excessive alcohol use. Aflutter is usually a sign of more significant problems so that might be what you are talking about aflutter being more significant
The a rate of a fib is 400-800 per minute and the amount of the a rate is what typically distinguishes the two. Afib can occur in people for lots of reasons including excessive alcohol use. Aflutter is usually a sign of more significant problems so that might be what you are talking about aflutter being more significant
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BrothaBill
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juicedpigtails said:
HAH! I realize that, I was thinking along different lines when I realized what you were getting at with one being more deadly than another I remembered that with aflutter the patients are usually in deep shit, so they have larger mortality than afib
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BrothaBill
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juicedpigtails said:
I had to study na and K potassium channels and physiology, medications and all that crap and rhythm and rate and just all the in depth bs, given all that, I just used flashcards to recognize patterns, then Id define the requirements needed for each diagnosis with my answer. I loved them damn flashcards, saved my ass on numerous occasions.
The reason why the lead II hookup is better is b/x the heart lies anterior, inferior, 60degrees to the left, 30 degrees from the horizontal. So basically the apex of the heart points to the left lower quadrant and allows for better amplitude detection
BrothaBill said:
blah. Na and K channels stuff. had that in patho and a whole bunch in experimental neurobiology.
want to send me those flashcards? $$$
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BrothaBill
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juicedpigtails said:
HA! I wouldnt know where to even start to look for them in all my materials from school, boxes of it.
Almost every basic EKG book has them though in the back section., you should have no probs getting your hands on them. Or just make your own, drawing the pattern and the defining criteria on the back will help you learn it better. Ive drawn thousands of patterns by hand b/c I am a kinesthetic learner as well.
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BrothaBill
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samoth said:
