Well, I think I go with Zaid..

I don't see QRS complexes wide at all, they're within normal length, it should not be ventricular focus..rather normal conduction..and the rate is constant..

for P wave rate, it's also constant, the only thing there is no relationship between it and QRS...but why!?

waiting for ur answer Dr.Ahmed. Nice topic really, thanks.

Nour

dear zaid and nour

why u want the QRS complexes to be wide? it's complete heart block not bundle branch block. when the impulse generated in the SA node fails to reach the ventricles, some tissue in the ventricles will take the role of generating impulses (called escape rythme) so ventricles will beat "normally" but at a slower rate and independently of the atria.

in 3rd degree AV block, the QRS can be wide if the new source of generating impulses was distal in the ventrical but if it was proximal like in the bundle of His, the QRS would be narrow.

smiles

Hello hammodi

Well after a long discussion with you...

I think the reason of my argument is whether Third Degree heart block should have a normal atrial conduction, : ( P wave).
and would this be affected with Normal or abnormal QRS waves ?

1 . IT seems P wave can still not be affected if the block is at bundle of His, or AV node.

2. IF the block is at AV node, or at Bunldle of HIs, this means there should be another site to generate impulse, I suppose this should be junctional...nodal impulse.

3. since nodal impulse does not have P wave...I think this is not a rule here in Third degree heart block...coz P wave are present, and they can still be normal..

Meaning..the normal QRS waves...can be still due to AV junction, and yet they are as the criteria for AV junctional QRS, narrow.!!!!

This is the only way I can undersatnd and explain This ECG...

I had to search for more:

http://www.americanheart.org/presenter.jhtml?identifier=564

THanks Hammodi...still would be interested to know if the above sounds sensible or not...

Best...Nour

hi nour

i checked davidson and this is what is written, "When AV conduction fails completely, the atria and ventricles beat independently (AV dissociation-see Fig. 12.55). Ventricular activity is maintained by an escape rhythm arising in the bundle of His (narrow QRS complexes) or the distal conducting tissues (broad QRS complexes). Distal escape rhythms tend to be slower and less reliable."

so u see, it can be narrow or wide depending on where is the block (proximal or distal).

and btw it's cool that for once we r discussing medical stuff thanks nour and ahmed too for starting the topic

smiles

Hi Hammodi...

I didn't say that it is a must to find an abnormal QRS complex but I said it is usually expected to find it widened and at slower rate...


Here is what I found in "ECG Made Easy"
- Third Degree (complete) Block
*No relationship between R waves and QRS complexes.
*Usually, wide QRS complexes.
*Usual QRS complex rate less than 50/min.
*Sometimes narrow QRS complexes, rate 50-60/min.

Also See Table 3.1 Recognizing ECG Abnormalities


Really nice discussion

Really very nice discussion ..

I made go back to your books & feed back your knowledge ..

My father always tell me this Old English Qoute :
" The Doctor is still a student untill he dies "

So, it is our fate to read & read ..

& I hope U enjoy these medical subjects ..

& I hope our STAGERS participate in these medical topics as they do in other ones ..

Keep on doctors ..


-----------------------
Ahmed A. AL-Jubouri

Thanks Dr. Ahmed,
It's actually your high motive and activity that's making things glittering around. THanks to your great father..to make such a great son and doctor .

Navigator, I thought so too...in ECG made easy. But it needs more than ECG made easy to undersatnd details...that's what I learnt with more questioning.

Have a good day. Oh, and thanks Zaid for your words, I hope I get to know you more in my second term! if you're around!!

You are quite right Nour about reading other than "ECG Made easy" and that's what I'm aiming for...

Thanks GOD I'm still in Iraq but unfortunately I'm away from beloved Baghdad...

hi guys

what's the axis of this ECG, and if u want to make it harder, tell us the value of the axis not just if it's normal, left or right deviation.



smiles

Hi

According to Dr.Adnan.s nice trick ... It is Right Axis Deviation but about the value of the axis I don't know

I concur with Dr. Navigator.Regarding the value of the axis I think its for alertring us to look for other signs of Rt. or Lt. ventricular hypertrophy.

In this ex. we may have pulmonary problems or congenital heart disease.

Thank you and Bgrds.

hi

u r right, it is right axis deviation. as for the value, i guess there's no use knowing it except that it shows that u understand the axis completely. the axis here is 150

Revise ECG made easy - Sixth Edition - PAGE 18 under title " Why worry about the cardiac axis "

To know the value of the axes.

Thank you Dr. waiting for more.

God bless you Fellows

hi

i thought i'd revive this topic.

mention the causes of dominant R in V1? (they're 4)

enjoy

HII


1- RT BUNDLE BRANCH BLOCK
2- POST MI
3- TYPE A WOLF PARKINSON WHITE SYNDROM
4- RT VENTRICULAR HYPERTROPHY


THANX