Telemetry Quiz February 11th, 2012 Dr. Irving Tiong Dr. Darren Kagal 12-01-31 12-01-31 Telemetry Quiz February 11th, 2012 Dr. Irving Tiong Dr. Darren Kagal 1

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A. Atrial fibrillation B. Atrial flutter C. Sinus tachycardia D. SVT 12-01-31 12-01-31 A. Atrial fibrillation B. Atrial flutter C. Sinus tachycardia D. SVT c 3

A. Atrial fibrillation B. Atrial flutter C. Sinus tachycardia D. SVT 12-01-31 12-01-31 A. Atrial fibrillation B. Atrial flutter C. Sinus tachycardia D. SVT c 4

12-01-31 12-01-31 St elevation 5 5

What is the cause of chest pain? 12-01-31 12-01-31 What is the cause of chest pain? A. Stomach acid B. Acute coronary syndrome- call CODE STEMI C. Psychological stress D. Bad reaction to hospital food b 6

What is the cause of chest pain? 12-01-31 12-01-31 What is the cause of chest pain? A. Stomach acid B. Acute coronary syndrome- call CODE STEMI C. Psychological stress D. Bad reaction to hospital food b 7

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C. Ventricular tachycardia D. Looks pretty bad- call a “Code Blue” 12-01-31 12-01-31 A. Atrial fibrillation B. Artifact C. Ventricular tachycardia D. Looks pretty bad- call a “Code Blue” d 9

C. Ventricular tachycardia D. Looks pretty bad- call a “Code Blue” 12-01-31 12-01-31 A. Atrial fibrillation B. Artifact C. Ventricular tachycardia D. Looks pretty bad- call a “Code Blue” d 10

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D. Don’t know. Hope it won’t happen again 12-01-31 12-01-31 A. SVT B. VT C. Artifact D. Don’t know. Hope it won’t happen again c 12

D. Don’t know. Hope it won’t happen again 12-01-31 12-01-31 A. SVT B. VT C. Artifact D. Don’t know. Hope it won’t happen again c 13

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B. Second degree Mobitz I (Wenchebach) C. Second degree Mobiz II 12-01-31 12-01-31 A. Complete Heart block B. Second degree Mobitz I (Wenchebach) C. Second degree Mobiz II D. Complete heart block b 15

B. Second degree Mobitz I (Wenchebach) C. Second degree Mobiz II 12-01-31 12-01-31 A. Complete Heart block B. Second degree Mobitz I (Wenchebach) C. Second degree Mobiz II D. Complete heart block b 16

What is wrong with this strip? 12-01-31

Normal Atrial fibrilation First degree AV block Prolonged QT interval 12-01-31

Normal Atrial fibrilation First degree AV block Prolonged QT interval 12-01-31

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What Should You Do? A. Go back to sleep. Patient is likely on a walk 12-01-31 12-01-31 What Should You Do? A. Go back to sleep. Patient is likely on a walk B. Quickly assess patient. Ensure leads are properly on. Ensure gain is up. If no change call Code Blue C. Start compressions D. Call a CODE BROWN b 21

What Should You Do? A. Go back to sleep. Patient is likely on a walk 12-01-31 12-01-31 What Should You Do? A. Go back to sleep. Patient is likely on a walk B. Quickly assess patient. Ensure leads are properly on. Ensure gain is up. If no change call Code Blue C. Start compressions D. Call a CODE BROWN b 22

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D. Ventricular fibrillation 12-01-31 12-01-31 A. Atrial tachycardia B. Atrial Flutter C. Ventricular flutter D. Ventricular fibrillation b 24

D. Ventricular fibrillation 12-01-31 12-01-31 A. Atrial tachycardia B. Atrial Flutter C. Ventricular flutter D. Ventricular fibrillation b 25

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A. Ventricular fibrillation B. Atrial flutter C. Atrial fibrillation 12-01-31 12-01-31 A. Ventricular fibrillation B. Atrial flutter C. Atrial fibrillation D. Sinus tachycardia c 27

A. Ventricular fibrillation B. Atrial flutter C. Atrial fibrillation 12-01-31 12-01-31 A. Ventricular fibrillation B. Atrial flutter C. Atrial fibrillation D. Sinus tachycardia c 28

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C. Supraventricular tachycardia D. Subventricular tachycardia 12-01-31 12-01-31 A. Atrial flutter B. Atrial fibrillation C. Supraventricular tachycardia D. Subventricular tachycardia c 30

C. Supraventricular tachycardia D. Subventricular tachycardia 12-01-31 12-01-31 A. Atrial flutter B. Atrial fibrillation C. Supraventricular tachycardia D. Subventricular tachycardia c 31

12-01-31 12-01-31 safeR 32 32

A. Poor ventricular sensing B. Poor ventricular capture 12-01-31 12-01-31 A. Poor ventricular sensing B. Poor ventricular capture C. Pacemaker mediated tachycardia D. Pacemaker is working fine. Go back to sleep. d 33

A. Poor ventricular sensing B. Poor ventricular capture 12-01-31 12-01-31 A. Poor ventricular sensing B. Poor ventricular capture C. Pacemaker mediated tachycardia D. Pacemaker is working fine. Go back to sleep. d 34

Ventricular tachycardia Artifact D. Ventricular bigeminy 12-01-31 Atrial bigeminy Ventricular tachycardia Artifact D. Ventricular bigeminy D

Ventricular tachycardia Artifact D. Ventricular bigeminy 12-01-31 Atrial bigeminy Ventricular tachycardia Artifact D. Ventricular bigeminy D

12-01-31 A. Atrial Fibrillation B. Ventricular Fibrillation C. Sinus tachycardia D. Atrial tachycardia D

12-01-31 A. Atrial Fibrillation B. Ventricular Fibrillation C. Sinus tachycardia D. Atrial tachycardia D

12-01-31 A. Atrial fibrillation B. Sinus node disease (sinus pauses) C. Normal rhythm D. Ventricular fibrillation B

12-01-31 A. Atrial fibrillation B. Sinus node disease (sinus pauses) C. Normal rhythm D. Ventricular fibrillation B

12-01-31 A. First degree AV block B. PVCs C. Second degree AV block Mobitz II D. Wenchebach D

12-01-31 A. First degree AV block B. PVCs C. Second degree AV block Mobitz II D. Wenchebach D

Premature atrial complex 12-01-31 Premature atrial complex Premature ventricular complex with R on T phenomenon Sinus tachycardia D. Sinus pause B

Premature atrial complex 12-01-31 Premature atrial complex Premature ventricular complex with R on T phenomenon Sinus tachycardia D. Sinus pause B

12-01-31 A. Normal sinus rhythm B. Isorhythmic dissociation C. Complete heart block D. First degree heart block D

12-01-31 A. Normal sinus rhythm B. Isorhythmic dissociation C. Complete heart block D. First degree heart block D

12-01-31 A. Completely normal rhythm. B. Completed anterior myocardial infarction. C. Complete heart block. D. Completely challenging rhythm. B

12-01-31 A. Completely normal rhythm. B. Completed anterior myocardial infarction. C. Complete heart block. D. Completely challenging rhythm. B

12-01-31 A. Normal sinus rhythm B. VVI pacemaker. C. DDD pacemaker D. DDD pacemaker with atrial undersensing D

12-01-31 A. Normal sinus rhythm B. VVI pacemaker. C. DDD pacemaker D. DDD pacemaker with atrial undersensing D

12-01-31 A. Normal DDD pacemaker function B. Atrial undersensing C. Ventricular undersensing D. Can’t figure it out. Call EP!! A

12-01-31 A. Normal DDD pacemaker function B. Atrial undersensing C. Ventricular undersensing D. Can’t figure it out. Call EP!! A

A. Normal sinus rhythm B. Loss of capture C. Oversensing D. ICD shock 12-01-31 A. Normal sinus rhythm B. Loss of capture C. Oversensing D. ICD shock B

A. Normal sinus rhythm B. Loss of capture C. Oversensing D. ICD shock 12-01-31 A. Normal sinus rhythm B. Loss of capture C. Oversensing D. ICD shock B

12-01-31 12-01-31 Quiz Part 2 65

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D. Second degree, Mobitz I 12-01-31 A. Sinus tachycardia B. Atrial flutter C. Third Degree AV block D. Second degree, Mobitz I d 12-01-31

D. Second degree, Mobitz I 12-01-31 A. Sinus tachycardia B. Atrial flutter C. Third Degree AV block D. Second degree, Mobitz I d 12-01-31

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Second degree AV block Mobitz I First degree AV block Sinus bradycardia Second degree AV block Mobitz I First degree AV block Third degree AV block 12-01-31

12-01-31 12-01-31 Complete heart block 72

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Multifocal atrial tachycardia Atrial tachycardia Atrial Fibrillation Sinus tachycardia Multifocal atrial tachycardia Atrial tachycardia 12-01-31

Multifocal atrial tachycardia Atrial tachycardia Atrial Fibrillation Sinus tachycardia Multifocal atrial tachycardia Atrial tachycardia 12-01-31

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Second degree AV block, Mobitz II Second degree AV block, Mobitz I 12-01-31 Complete AV block Second degree AV block, Mobitz II Second degree AV block, Mobitz I Sinus bradycardia with junctional escape (Isorhythmic disassociation) a 12-01-31

Second degree AV block, Mobitz II Second degree AV block, Mobitz I 12-01-31 Complete AV block Second degree AV block, Mobitz II Second degree AV block, Mobitz I Sinus bradycardia with junctional escape (Isorhythmic disassociation) a 12-01-31

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Ventricular tachycardia Atrial fibrillation SVT with aberrancy 12-01-31 Ventricular tachycardia Atrial fibrillation SVT with aberrancy Atrial tachycardia d 12-01-31

Ventricular tachycardia Atrial fibrillation SVT with aberrancy 12-01-31 Ventricular tachycardia Atrial fibrillation SVT with aberrancy Atrial tachycardia d 12-01-31

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Pacemaker oversensing Pacemaker undersensing 12-01-31 Pacemaker oversensing Pacemaker undersensing Pacemaker over and undersensing Doctor connected the leads the wrong way during implant. d 12-01-31

Pacemaker oversensing Pacemaker undersensing 12-01-31 Pacemaker oversensing Pacemaker undersensing Pacemaker over and undersensing Doctor connected the leads the wrong way during implant. d 12-01-31

12-01-31 12-01-31 Dual chamber pacemaker with lead reversal (atrial lead connected to ventricular port and vice versa 86

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Supraventricular tachycardia with aberrancy First degree AV block 12-01-31 Supraventricular tachycardia with aberrancy First degree AV block Non sustained Ventricular tachycardia Complete heart block with ventricular escape c 12-01-31

Supraventricular tachycardia with aberrancy First degree AV block 12-01-31 Supraventricular tachycardia with aberrancy First degree AV block Non sustained Ventricular tachycardia Complete heart block with ventricular escape c 12-01-31

What are the blue arrows signifying? 12-01-31 12-01-31 Bonus Question What are the blue arrows signifying? 90

Intermittent retrograde p waves (V-A conduction) 12-01-31 Artifact? ST elevations? Intermittent retrograde p waves (V-A conduction) Atrial flutter with concomitant VT c 12-01-31

Intermittent retrograde p waves (V-A conduction) 12-01-31 Artifact? ST elevations? Intermittent retrograde p waves (V-A conduction) Atrial flutter with concomitant VT c 12-01-31

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Second degree, Mobitz One Second degree, Mobitz Two First degree AV block Second degree, Mobitz One Second degree, Mobitz Two Third degree AV block 12-01-31

Second degree, Mobitz One Second degree, Mobitz Two First degree AV block Second degree, Mobitz One Second degree, Mobitz Two Third degree AV block 12-01-31

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Supraventricular tachycardia Sinus bradycardia Atrial flutter Atrial fibrillation Supraventricular tachycardia Sinus bradycardia Atrial flutter 12-01-31

Supraventricular tachycardia Sinus bradycardia Atrial flutter Atrial fibrillation Supraventricular tachycardia Sinus bradycardia Atrial flutter 12-01-31

12-01-31 Bonus Question: If Atrial Fibrillation, Why is there a regular rhythm (stable R-R)?

It is not atrial fibrillation? 12-01-31 It is actually irregular, but not irregular enough to be seen by the naked eye. It is not atrial fibrillation? Atrial fibrillation with complete AV block, and escape junctional rhythm I do not know. I would call EP. c 12-01-31

It is not atrial fibrillation? 12-01-31 It is actually irregular, but not irregular enough to be seen by the naked eye. It is not atrial fibrillation? Atrial fibrillation with complete AV block, and escape junctional rhythm I do not know. I would call EP. c 12-01-31

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Ventricular fibrillation Atrial fibrillation Artifact 12-01-31 Torsade de Pointe Ventricular fibrillation Atrial fibrillation Artifact d 12-01-31

Ventricular fibrillation Atrial fibrillation Artifact 12-01-31 Torsade de Pointe Ventricular fibrillation Atrial fibrillation Artifact d 12-01-31

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Ventricular fibrillation Atrial fibrillation Artifact 12-01-31 Torsade de Pointe Ventricular fibrillation Atrial fibrillation Artifact a 12-01-31

Ventricular fibrillation Atrial fibrillation Artifact 12-01-31 Torsade de Pointe Ventricular fibrillation Atrial fibrillation Artifact a 12-01-31

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Second degree AV block, Mobitz II, and PVC PVC. Normal sinus rhythm 12-01-31 Normal sinus rhythm Second degree AV block, Mobitz II, and PVC PVC. Normal sinus rhythm PVC and PAC, then initiating SVT. b 12-01-31

Second degree AV block, Mobitz II, and PVC PVC. Normal sinus rhythm 12-01-31 Normal sinus rhythm Second degree AV block, Mobitz II, and PVC PVC. Normal sinus rhythm PVC and PAC, then initiating SVT. b 12-01-31

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Atrial fibrillation and pause Junctional bradycardia 12-01-31 Sinus pause Atrial fibrillation and pause Junctional bradycardia Ventricular bradycardia b 12-01-31

Atrial fibrillation and pause Junctional bradycardia 12-01-31 Sinus pause Atrial fibrillation and pause Junctional bradycardia Ventricular bradycardia b 12-01-31

12-01-31 Bonus Question: How long is the pause?

12-01-31 ~2 seconds ~3 seconds ~4 seconds ~5 seconds d 12-01-31

12-01-31 ~2 seconds ~3 seconds ~4 seconds ~5 seconds d 12-01-31

Thank you for your attention! 12-01-31