Quote from Dinith88
1) my last post wasn't directed at yours, but i'll reply to your post..
2) Abnormal condution pathways are usually responsible for atrial dysrhythmias, not PVC's. That is the stuff of a different thread, like 'what causes svt or wpw, etc.'... so it's kinda irrelevant here
3) By 'Fluff', i meant that discussion of other sources of wide-bizarre complexes in a-fib is inconsequential to the origional question. the answer is 'yes..pvc's occur in a-fib'. Ashmans, abberant pathways, etc. is kinda like a different discussion..
4) You're mistaken with your '3 basic dysrhytmias'...Indeed, AFib/Flutter are both SV dysrhythmias..so actually there are only 2..atrial or ventricular (SV simply means the arrhythmia is occuring above the ventricles (ie in the atria)
5) Cardiac tissue DOES become irritable (can happen in more ways than one). a) have you ever pulled a SWAN and seen pvc's (happens all the time) because the catheter passes through and 'irritates' the Right ventricle b) ischemic insult obviously causes cardiac irritability... thats where MI related VT/VF comes from c)cardiac tissue can become irritable in electrolyte disturbances and cause pvc's. d) by 'irritable' i dont mean itchy, but your attempt at the humorous 'itch-cream' analogy was actually a good one...for instance lidocaine directly 'numbs' and sooths irritated heart muscle and lessens ventricular ectopy...
6)i'll stop short of picking your post completely apart because i have an awful record of getting my posts pulled for flaming...
7)ep book? I've worked with ep-docs for a number of years and am very familiar with arrythmias, their cause, and treatment.
8)I think you should re-read my previous posts because i'm not sure if you understood them..or perhaps you should get a simpler ep-book.
9) i apologize if you thought my last post was an attempt at bashing yours
Ouch... don't take much to set you off, does it?
I won't argue, shucks, I worked with E/P docs and all that for years, too, but they were probably not real good. We're kind of hayseeds sometimes here in the midwest. Thanks for bein' a good Church-goin' type and not tearing me to shreads in public. I'm beholdin' to ya.
If I can find a less highfalutin' book than Foguros, I will, 'cause I know they have an A&P coloring book out there, too, and maybe there's a market for some really simple E/P learnin's. ("Alice and Jerry meet Dr. Jackman at NASPE"?) Don't tell anyone, but you wouldn't believe who I got drunk with one year at NASPE accidentally, but it wasn't Jackman.
Anyhow, I give up, I didn't mean nothin'. No need to have a big donnybrook over a specialty that's still in it's childhood like E/P is. (Unless you want to bring Wenkebach into it,counting the pulse and watching the jugular veins.) Why I remember, back in my day, they used to send people over from Europe to our facility so that a cardiac surgeon could ablate WPW. They'd bring this skinny little doctor and all these big machines with dials and knobs and more buttons than a dog's got fleas on this cart into the room... And believe it or not, sometimes we used to sew these patches kinda looked like a fly swatter right slap onto
the heart for ICDs (AICDs back then, 'till Medtronic and all them had to stick their nose in.). I think it was for PVCs, but we weren't sure what they really were, 'cause the heart was still a-beatin' and we didn't have your phone number.
I'll tell ya, those were the days, though, these kids don't know how good they have it now. I mean that. I used to walk 1 1/2 miles from the parking garage in the snow every morning...didn't think anything about it...but we were happy with what we had even if we didn't know a PVC from Adam's cat.
No shame for me to have been outdone by you, 'cause I didn't mean nothin in the first place, and I'm still trying to figure out why lidocaine doesn't supress overdrive pacing and what I'm gonna call them big waves
during S/G removal. I mean, you keep a-sayin' the ventricles are really irritable, and here I thought you just take it down to the level of a cell, being troubled by what a feller calls "mechanical stimuli". Then somehow that starts to settin' off the cells around it 'cause of them ions gettin' sucked into the first cell. Like skippin' a rock in the lake when you're a kid, but different. ((But off the subject, since you seem to have a pretty good knowledge of stimuli and response and these sorts of things, maybe you know; if you are ticklish to begin with, why can't you tickle yourself?) (And why did Kamikazie pilots wear helmets?)[ And if you put enough lidocaine in the lake would that make the water less irritable and make smaller waves?])). I think a lot sometimes.
...Thanks for your restraint and your gentle counsel. I gotta go, I'm checkin' for a bad Christmas light on the trailer, I think it's a green one, I ain't plugged 'em in since last year, just left 'em up, that's what we do in the neighborhood. Now I gotta find out which one's burned out, Then after that I gotta run over at Jimbo's and help him carry the plaster Virgin Mary on the Half Shell in so's he can touch it up, and drink a few cold ones. His wife's funny about that every year with the Mary.