ACLS Certification Blog

Oct 13
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Atrial tachycardia and other ectopic rhythms, which originate in the atria, occur outside the sinus nodes, and they create action potentials faster than the sinus node, which enables them to become the primary pacemaker of the heart. When any atrial rate is greater than 100 beats per minute, the term for the rhythm is atrial tachycardia. However, if the rate is less than 100 beats per minute, the term is ectopic atrial rhythm.When the origin of electrical activity is not from the sinus node, the P wave do…
Sep 18
The patient mentioned in the question of the day displayed an early repolarization pattern on his ECG. This is a common ECG variant, and is defined by J point elevation on ECG of greater than or equal to 0.1 mV in two adjacent leads, which appear as terminal QRS slurring during the transition from the QRS segment to the ST segment, or as a positive deflection on the terminal QRS complex, which appears as a notch, followed by a concave upward ST-segment elevation, with prominent T waves in two or more contig…
Sep 07
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Any discussion of hyperkalemia should begin with the statement that potassium is a critical electrolyte for cellular function of all cells, but when considered with respect to cardiac physiology, its effect is magnified.The myocardial cells depend upon a normal serum potassium level that is between 3.5 and 5.0 mEq/L. The body’s total potassium concentration is much higher than reflected in the serum, because most of the body’s potassium remains within the cells. Understanding the role of potassium in main…
Sep 04
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I recently posted an ECG with diffuse ST segment elevations in all leads. It was the ECG of a patient with pericarditis. Pericarditis can result in an ECG that may appear alarming, if you don’t look carefully.  Find another characteristic ECG below: The disease is an inflammation of the sac that closely adheres to the heart, known as the pericardium.The pericardium has two layers, which have a “potential space” between them. Normally there are only 10 to 15 milliliters of fluid in this space, lubric…
Aug 31
Someone asked this question the other day in a thread, and I had planned to write a blog post about it – but there really isn’t much to say. At some point, life ends for all of us. When you are resuscitating someone from a terminal rhythm, you should be aware that the rhythm progression is often somewhere along a continuum from ventricular tachycardia to ventricular fibrillation to PEA and asystole. At some point, you will have tried all of the interventions available to you, and the patient will have been …
Aug 28
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It is time for a short blog post on mechanisms of ventricular tachycardia. Most sudden cardiac deaths are due to ventricular tachycardia or ventricular fibrillation. It is estimated that over 300,000 deaths per year in the United States are due to ventricular tachycardia or ventricular fibrillation. Ventricular tachycardia is a broad term that refers to rhythms faster than 100 beats per minute, with 3 or more irregular beats in a row, which arise distal to the bundle of His. Arrhythmias are caused by either…
Aug 22
For years, it has been recognized that alcohol may cause a cardiomyopathy. It is identical in structure and function to idiopathic dilated cardiomyopathy, but it is a secondary cardiomyopathy, recognized to be due to alcohol use. However, that's just a lead in to "holiday heart."Over the past few decades, alcohol has been determined to be an arrhythmogenic agent after short-term consumption, in patients without clinically evident cardiomyopathy or heart failure. A study done in 1978 evaluated 32 episodes …
Aug 17
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Question: Your patient is in PEA. You are looking for reversible causes. Prior to losing his pulse, he exhibited JVD and a low voltage rhythm on his monitor, with muffled heart sounds. What do you think his condition has resulted from? How will you treat him?Answer: This patient has pericardial tamponade, most likely. The classical signs are JVD, hypotension, and muffled heart sounds. In PEA, CPR is critical, and the algorithm specifies CPR and epinephrine. But what about that reversible cause?First, …
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