Vagal Hypertonia is a topic that is often confusing and misunderstood. And although we have touched on the topic briefly in the past, Dr Harry Mond delves a little deeper in a bid to clear up any confusion.
Read moreWhile the QT Interval is a topic that few Cardiologists are experienced in, we review several aspects including how it can be measured, while discussing some of the surrounding controversies.
Read moreIn the last of the Wenckebach case study series, Dr Harry Mond explores several ECGs with fascicular Wenckebach AV sequences with a reminder to always question the tracings!
Read moreDr Harry Mond explores the various arrhythmic events that can interrupt and terminate Wenckebach AV sequences including non-conducted atrial ectopics.
Read moreNot all ECG recordings are straightforward, as illustrated by this "bizarre" ECG. In this latest edition in our clinical case studies series, our Medical Director Dr Harry Mond explains how he assessed an ECG he was asked to look at, and how eliminated incorrect solutions...
Read moreWe explore the many variations of Wenckebach AV block with a pivotal focus on the atypical, typical and absolute occurrences. We also define the three features needed in order to make a correct diagnosis.
Read moreDr Harry Mond shows us an example of the all too common busy ECG and explores how to report on them successfully.
Read moreGroup beating always provide fascinating ECGs! This week, we take a look at several different combinations of ectopy sequences including ventricular and atrial trigemilets, ventricular bigemilets and more.
Read moreDr Harry Mond explores another form of ECG interference often referred to as 'subtle artefact' which can mimic cardiac arrhythmias and sometimes lead to serious misdiagnoses and inappropriate treatments.
Read moreAn ECG artefact is an inscription on an ECG tracing that doesn't originate from a cardiac source. Dr Harry Mond teaches us how to recognise artefact on an ECG and what causes the different types of interference to prevent ECG misdiagnosis.
Read moreDr Harry Mond visits the early history and recent technological advances in pacing therapies for the treatment of tachyarrhythmias.
Read moreContinuing our pacing series, Dr Harry Mond explores pacing and coronary artery disease, alongside the valuable ECG clues for its detection which should not be ignored.
Read moreRight ventricular pacing may, over time, result in left ventricular dysfunction. This week Dr Harry Mond explores the range of minimisation algorithms developed for its management, while reviewing the law of AV conduction.
Read moreDr Harry Mond visits Pacemaker Mediated Tachycardia and explores the two types of programmable algorithms, 'prevention detection' and 'intervention' for its successful treatment.
Read moreNot all ECG recordings are straightforward, as illustrated by this "bizarre" ECG. In this latest edition in our clinical case studies series, our Medical Director Dr Harry Mond explains how he assessed an ECG he was asked to look at, and how eliminated incorrect solutions...
Read moreDr Harry Mond explores rate adaptive pacing where he highlights minute ventilation and closed loop stimulation (CLS) reminding us of the importance of pattern recognition in the prevention of repeating ECGs.
Read moreFurther to our pacing series, Dr Harry Mond analyses one of the most difficult cases he has seen in a bid to teach us about Conduction System Pacing and how 'His' bundle pacing can be recognised.
Read moreDr Harry Mond compares the well defined and easily identifiable ECG appearances of pacemaker-ventricular block and pacemaker-atrial block and how it allows us to interpret even the most bizarre pacing ECGs.
Read moreThis week, Dr Harry Mond explores biventricular pacing, often referred to as simultaneous depolarisation of the right and left ventricles and how it's an indication for permanent cardiac pacing.
Read moreWhere am I pacing from? Dr Harry Mond discusses the four identifying ECG features in determining the pacing site in the atrium or ventricle that are often misunderstood. A reminder that it's not always just the timing, but also the positioning!
Read moreFurther to our Cardiac Pacing series, Medical Director Dr Harry Mond revisits the three letter code to teach us about Dual Chamber Pacing.
Read moreIn the first of a series on the electrocardiography of cardiac pacing, Assoc Prof Mond explores the fundamentals and everything you need to know about the stimulus artefact.
Read moreThis week we take a closer look at the AV delay by exploring the differences between the paced and sensed AV delay while focusing on the importance of the law of AV conduction.
Read moreNot all ECG recordings are straightforward, as illustrated by this "bizarre" ECG. In this latest edition in our clinical case studies series, our Medical Director Dr Harry Mond explains how he assessed an ECG he was asked to look at, and how eliminated incorrect solutions...
Read moreThis week Dr Harry Mond revisits the well-known and researched ventricular interpolation with a review of the footprints and exceptions to the rule in a bid to teach something new.
Read moreDisagreement over the use of the terms “incomplete” or “partial” right bundle branch block (RBBB) had us take a deeper look at what is established in literature as an rSr’ pattern in V1/V2 with a QRS of 100 -120 ms, and when to call normal,...
Read moreHanded this ECG, we were asked if it was an example of a rate adaptive pacing, which uses changes in transthoracic impedance to increase the pacemaker rate in response to physiologic demand. Assoc Prof H Mond explains how to find the correct diagnosis.
Read moreThis Holter tracings showed a number of 2.8 second nocturnal pauses. A bundle branch block is also present. So the question was asked: Is this high degree AV block and does the patient need a pacemaker?
Read moreThis week Dr Harry Mond reviews the ventricular ectopic compensatory pause with a focus on full and partial pauses while teaching us a lesson on timing.
Read moreThis is one that is sure to spark conversation as a topic we know little about. Assoc Prof Harry Mond suggests some may even disagree with his view, and invites you not to hesitate to make some noise!
Read moreAfter recently discussing the two most common variations of reversed arm and leg leads, we now explore combinations of Right Arm-Right Leg Reversed, including the double twists, & all the tell-tale footprints.
Read moreCan ECGs cause headaches? Well this one might! Leading on from our last ECG topic, this week we further explore twisted leads but involving all limbs with “leg leads on arms” & “arm leads on legs” & the major defining footprints.
Read moreLast week some of you suggested dextrocardia in response to our case of reversed arm leads. This week shows that with dextrocardia the chest leads are very different and how to avoid misdiagnosis
Read moreThis week, Assoc Prof Mond discusses abnormalities commonly missed by physicians when reporting on ECGs, with a focus on reversed arm leads and how to avoid serious misdiagnosis.
Read moreSomething rarely seen in Holter monitoring, the ventricular pentageminy with ventricular ectopics every 5th beat, and other curious rhythms!
Read moreLast week we proved not all bundle branch blocks are boring. Now we delve even deeper into mistaken rhythms, common misdiagnosis and those rarely talked about, including the crochetage sign
Read moreThis week Assoc Prof Mond discusses the not so boring bundle branch block while exploring some puzzling occurrences including alternating bundle branch block and bidirectional rhythm. The clue is in the rhythm strip.
Read moreOften asked to review cardiac pacing ECGs, this one was presented as intermittent failure of ventricular capture. Revisiting atrial pacing and the tell-tale clues, we’re able to make the correct diagnosis.
Read moreIn the final part of this 2-part series, we explore even more exotic ectopy, including ventricular couplets, interpolation, unipolar bigemilets, trigemilets and more.
Read moreA look at exotic ventricular ectopy this week, with 8 different examples, their footprints and the veritable kaleidoscope of findings that may result.
Read moreA controversial one this week: AFib with ventricular bigeminy. Or is it? Exploring trigeminy, ventricular parasystole, pseudo-ventricular parasystole and other possibilities, this one is sure to divide opinion.
Read moreIn the final part of this 2-part series, Assoc Prof H Mond further explores the different forms of atrial ectopy including the atrial couplet, triplet, run & non-conducted types.
Read moreIn part one of a two part series, Assoc Prof H Mond explores exotic atrial ectopy in all its forms, including the anatomy and characteristics of 12 different examples.
Read moreAssoc Prof Mond shares this case to delve into unusual and classical patterns of twisted leads in 12-lead ECG, including the double twist, and shares the tell-tale footprints of all.
Read moreAssoc Prof Harry Mond identifies a plethora of insights that come with studying Wenckebach sequences. This week, a definitely not boring look into atrioventricular (AV) and non-AV types, and how it’s all in the timing!
Read moreA ‘bizarre’ case of dual chamber pacing with an 80ms AV delay, called us for a second opinion! With examples of a) Atrial pacing at 50 bpm and prolonged AV delay b) Wenckebach AV block; & Ventricular paced beat after 2 secs, we deep dive...
Read moreThis week MD Assoc Prof H Mond examines the similarities between the characteristics of artefact vs non-atrioventricular Wenckebach blocks and the importance of recognising footprints for correct diagnosis.
Read moreExploring another ventricular aberration this week, we look at rate dependent bundle branch block, its defining characteristics, a number of important differential diagnoses and how to avoid serious misdiagnosis.
Read moreWith a pause about twice the cycle length of the R to R intervals and no P, QRS or T waves, this case tackles one of the most difficult explanations in ECG interpretation and demands a revisit to the fundamentals or “footprints” of Wenckebach AV...
Read moreIn this first of his Fun With ECG series, our MD Assoc Prof Harry Mond looks at this bizarre atrioventricular (AV) delay. Look closely at the ECG. The AV delay timings don’t make sense. The AV delay for atrial sensing/ventricular pacing (As Vp) is always...
Read moreIn this rare case, we see two very unusual and critical factors that together lead to atrial oversensing and “apparent” violation of the lower rate limit; a very narrow zone of open atrial sensing and far-field R wave sensing. While the first time MD Assoc...
Read moreFirst thoughts on this Holter tracing was artefact, but the native rhythm showed a regular pattern of irregularity! Taking a close look at overnight tracings when the rhythm would be slow and the “artefact” less likely, revealed what was really going on. In this case...
Read moreThe Holter monitor tracings of a 44-year old male caused a lot of excitement at CardioScan this week. With 12 bradycardia episodes overnight, it was initially considered Wenckebach AV block. While clinically, rather than visually, correct, it nevertheless, did not fulfil the footprints of Wenckebach...
Read moreSeen for the first time, the pattern in this 24hr histogram gives instantly recognisable clues about what is happening, even without looking at the tracings. Normally, we see a diurnal pattern of rate changes during the day with lower rates at night, but rarely a...
Read moreHanded this ECG, our Medical Director Assoc Prof Harry Mond was asked if it was an example of a rate adaptive pacing, which uses changes in transthoracic impedance to increase the pacemaker rate in response to physiologic demand. It was not a paced rhythm, however,...
Read moreSinus arrhythmia is unusual in a 63-yr-old but we were asked to amend a ‘normal’ result to reflect this diagnosis. With classical examples of the pattern in under 30s and showing how NOT to confuse it with atrial ectopy, Assoc Prod Harry Mond shows how...
Read moreShowing a number of 2.8 second nocturnal pauses and bundle branch block, this latest case begs the question: is this high degree AV block and does the patient need a pacemaker? Using 11 difference traces, Assoc Prof Harry Mond delves into the topic of Wenckebach...
Read moreThis ECG was reported as complete heart block, and at first glance it sure looks like it. But a closer examination revealed the ventricular response was irregular. In this latest case study Assoc Prof Harry Mond explains two P wave patterns that reveal the rhythm...
Read moreReported as dual chamber pacing, this case study needed closer examination. With obvious atrial pacing, the question of ventricular pacing remained. Assoc Prof Harry Mond details the characteristics that reveal the correct diagnosis, and why this should not be confused with pacemaker malfunction.
Read moreThe presentation of pseudo Wolff-Parkinson-White Syndrome recently had an international customer return a report with a note pointing out that we had missed the diagnosis of intermittent pre-excitation - the Wolff-Parkinson-White Syndrome. But as Assoc Prof Harry Mond explains in this latest cardiac case study,...
Read moreAtrial flutter or supraventricular tachycardia with block can often give the appearance of a bidirectional tachycardia, which can be caused by many other things. In this latest case study, our Medical Director Assoc Prof Harry Mond explains how to identify the characteristics of a tachycardia...
Read moreOvernight Wenckebach AV block is a common finding in young people and is usually found in the presence of sinus bradycardia/sinus slowing. In this latest edition in our clinical case studies series, we look at how to identify atypical Wenckebach AV block, and how it’s...
Read moreNot all ECG recordings are straightforward, as illustrated by this "bizarre" ECG. In this latest edition in our clinical case studies series, our Medical Director Dr Harry Mond explains how he assessed an ECG he was asked to look at, and how eliminated incorrect solutions...
Read moreReversed Wenckebach occurs when there is sequential shortening of the PR interval, and can require a permanent pacemaker in certain instances. In this latest case study, we take a look at examples of reversed Wenckebach, and how to recognise the rare ECG finding.
Read moreAll pacemaker companies have programmable algorithms to prevent ventricular pacing, but this can cause issues with Holter monitor test results. Our Medical Director, Dr Harry Mond, explains how pacemakers can confuse Holter monitor tracings, and how to correctly identify these algorithms on ECG patterns.
Read moreAs a rare find Wandering Atrial Pacemaker can be mistaken for marked sinus arrhythmia with unifocal atrial ectopics. Here, we look at the tell-tale characteristics that set them apart in another interesting case study by Medical Director Dr Harry Mond.
Read moreAtrial fibrillation (AF) is the leading cardiac cause of stroke. and its identification after a stroke or transient ischemic attack (TIA) is important for guiding secondary prevention management. However, paroxysmal AF frequently goes undetected and untreated if sufficient ECG monitoring is not performed. This study...
Read moreA recent ECG was reported as sinus rhythm with intermittent bundle branch block – but this diagnosis was incorrect. CardioScan’s Medical Director Dr Harry Mond discusses the identifying factors in the ECG, and how he reached his diagnosis of an idioventricular rhythm with isorhythmic AV...
Read moreThe term ectopic means ‘‘out of place” or ‘‘abnormal position” and, in relation to the heart, refers to an early heartbeat, whose origin is from a focus other than the sinus node. They increase in frequency with age and are generally innocent, unless there is...
Read moreThe term ectopic means “out of place” or “abnormal position” and, in relation to the heart, refers to an early or premature heartbeat, whose origin is from a focus other than the sinus node. Ventricular ectopics originate from an irritable focus within the ventricles and...
Read moreCompensatory pauses often follow atrial ectopics, but they can cause some confusion. In his latest case study, our Medical Director Dr Harry Mond clarifies the different types of compensatory pauses that can occur, as well as the typical characteristics of each compensatory pause as they...
Read moreAs the technology surrounding Holter monitors continues to evolve, more options becomes available – including Holters with multi-channels, versus one channel patch Holter monitors. Our Medical Director, Dr Harry Mond, looks at the differences between one channel and multi-channel Holter monitors, and which is better...
DownloadA cardiac arrhythmia is a rhythm disturbance of the heart which may require investigation using ambulatory electrocardiographic (ECG) monitoring. This may be a 24 hour or greater (Holter) or medium term (events and telemetry) recording which can be up to two weeks. Longer term recording...
Read moreThere are a number of computerised packages that can measure Holter ECG recordings over a 24 or shorter period. They require high quality tracings and despite being available in a Holter monitor report, none have been found to be useful in routine medical management. Access...
Read moreA recent Holter monitor report caused spirited debate amongst the team about whether it showed an atrial ectopic conducted with aberration, or a ventricular ectopic. CardioScan's Medical Director, Assoc Prof Harry Mond, analyses the ECG and explains who came to the correct conclusion, as well...
Read moreThis week, Assoc Prof Harry Mond looks at the upside down ECG, and the puzzling trace that resulted. Each week, as our Director of Medicine he shares the real findings of unusual traces discovered at CardioScan, and what they reveal.
Read moreThe surprising trace that made even the most experienced cardiologist take pause. In this case of a 'rebel without a pause', Medical Director Dr Harry Mond examines Wenckeback sequences and the confusion with complete heart block that can sometimes occur.
Read moreCorporeal and particularly extra-corporeal interference is a very common problem encountered with both resting electrocardiograph (ECG) tracings and ambulatory recordings. When subtle, the artefact can mimic cardiac arrhythmias, leading to incorrect interpretation of the tracings. There is also a complicated interference group, usually due to...
Read moreAmbulatory ECG (AECG) telemetry is typically used to evaluate symptoms such as syncope, dizziness, chest pain, palpitations, or shortness of breath, which may correlate with intermittent cardiac arrhythmias. Additionally, AECG is used to evaluate patient response to initiation, revision, or discontinuation of arrhythmic drug therapy...
Read moreThe resting 12-lead electrocardiogram is a surface record of the electrical activity of the heart plotted against time with the actual standardised recording of the non-invasive test being an electrocardiograph (ECG). The test has served as the gold standard for arrhythmia recognition. The resting 12-lead...
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