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![\"\"](\"http:\/\/electricant.net\/ekg\/striptease\/strip22.jpg\")
<\/a><\/p>\nFirst Glance:<\/strong><\/p>\n From across the room it looks like a slow regular wide-complex rhythm.<\/p>\n Discussion:<\/strong><\/p>\n It’s clearly regular, and the lower trace shows lovely P waves. The lower trace is marked as a ‘V’ lead, and with the biphasic positive -> negative P before every QRS this is most consistent with a placement in V1 or V2 (if we assume this is a sinus rhythm). So if we assume this is a septal lead, then with that morphology this is likely RBBB. The PR interval is long, @ ~320 ms, for a slam-dunk first degree block.<\/p>\n Notice that the V lead shows one or two mm of ST depression, but the voltage calibration is at 200% so it would be hard to know whether this is significant from this lead alone.<\/p>\n The rate is in the mid 50’s. Some folks call this bradycardia, some don’t.<\/p>\n Final Impression?<\/strong><\/p>\n Sinus borderline bradycadia with first degree block and RBBB.<\/p>\n Management implications:<\/strong><\/p>\n A 12L would be good to evaluate for possible ischemia, otherwise there is not much here to suggest specific acute pathology. The combination of a first degree block (AV node disease) and a bundle branch block (conduction pathway disease) implies significant conduction disease.<\/p>\n \u00a0The Take-home Point:<\/strong><\/p>\n Jack up the gain to see the P waves.<\/p>\n The atria confirm your rhythm diagnosis. See how much easier it is to see the P waves at 200%? If the gain on the lower lead were at 100% it would be difficult to differentiate this from an accelerated idioventricular rhythm, or junctional rhythm with aberrancy.<\/p>\n <\/p>\n <\/p>\n sinus rhythm with conduction disease First Glance: From across the room it looks like a slow regular wide-complex rhythm. Discussion: It’s clearly regular, and the lower trace shows lovely P waves. The lower trace is marked as a ‘V’ lead, and with the biphasic positive -> negative P before every QRS this is most consistent …read more<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[4],"class_list":["post-305","post","type-post","status-publish","format-standard","hentry","category-cases","tag-1star"],"_links":{"self":[{"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/posts\/305","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/comments?post=305"}],"version-history":[{"count":6,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/posts\/305\/revisions"}],"predecessor-version":[{"id":307,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/posts\/305\/revisions\/307"}],"wp:attachment":[{"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/media?parent=305"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/categories?post=305"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/tags?post=305"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}<\/a>One star strip. Students should identify the rhythm correctly.<\/em><\/p>\n—> see the next strip<\/a><\/h1>\n","protected":false},"excerpt":{"rendered":"