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eFigure 12–8. Atrial fibrillation in Wolff-Parkinson-White (WPW) syndrome. A, B, and D: Rapid, wide, irregular QRS complex tachycardia with varying QRS complex morphologies. C: The direction of cardiac impulse conduction in a WPW syndrome patient during atrial fibrillation. The two arrows indicate the direction of the impulse movement, both anterograde from atrial (A) tissues to ventricular (V) tissues through both the accessory pathway (AP) and the atrioventricular node (AVN). The larger of the two arrows indicates that the majority of impulses travel to the ventricular via the AP. E: A 12-lead ECG demonstrating a rapid, wide, irregular QRS complex tachycardia with varying QRS complex morphologies. LBB, left bundle branch; RBB, right bundle branch; SAN, sinoatrial node. (Reproduced, with permission, from Tintinalli JE, Ma OJ, Yealy DM, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9th ed. McGraw-Hill, 2020.) A multi-part illustration depicts E C G tracings indicative of atrial fibrillation in W P W syndrome.

Current Medical Diagnosis & Treatment 2024 > PSVT Due to Accessory AV Pathways (Preexcitation Syndromes)

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Figure 39–1. ECG shows leads II and V5 in a patient whose body temperature is 24°C. Note the bradycardia and Osborn waves. These findings become more prominent as the body temperature lowers and gradually resolve with rewarming. Osborn waves have an extra positive deflection in the terminal portion of the QRS complex and are best seen in the inferior and lateral precordial leads (most notably in leads II, V5, and V6). An electrocardiogram shows the waves formed from leads 2 and V 5.

Current Medical Diagnosis & Treatment 2024 > Accidental Systemic Hypothermia

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Figure 40–2. Cardiac arrhythmias resulting from tricyclic antidepressant overdose. A: Delayed intraventricular conduction results in prolonged QRS interval (0.18 seconds). B and C: Supraventricular tachycardia with progressive widening of QRS complexes mimics ventricular tachycardia. (Reproduced with permission from Benowitz NL, Goldschlager N. Cardiac disturbances in the toxicologic patient. In: Haddad LM, Winchester JF [editors], Clinical Management of Poisoning and Drug Overdose, 3rd edition. Saunders/Elsevier, 1998.) Three cardiograms, A, B, and C, illustrate specific arrhythmias.

Current Medical Diagnosis & Treatment 2024 > Tricyclic & Other Antidepressants Overdose

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eFigure 10–22. The ECG is from a 33-year-old man with a large ventricular septal defect and moderately severe pulmonary hypertension. The right axis deviation (+115 degrees) and the tall R waves in leads V1 and V2 reflect the RVH, while the deep S waves in leads V2 and V3 and the well preserved R waves in leads V5 and V6 reflect the LVH. This ECG pattern, with the large equiphasic QRS complexes in the mid precordial leads, is characteristic of the biventricular hypertrophy that accompanies ventricular septal defects and is referred to as the Katz-Wachtel pattern. Reproduced with permission from Leonard S. Gettes, MD. https://www.understandingecg.com. An electrocardiograph tracing from a patient with biventricular hypertrophy.

Current Medical Diagnosis & Treatment 2024 > Ventricular Septal Defect

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