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![\"\"](\"http:\/\/electricant.net\/ekg\/striptease\/strip48.jpg\")
<\/a><\/p>\nFirst Glance:<\/strong><\/p>\n From across the room it looks like sinus rhythm.<\/p>\n Discussion:<\/strong><\/p>\n This looks like sinus rhythm, with a positive P in lead III (as expected) with flattened inverted T waves. The QRS complexes are narrow, with a hint of rSr’ in III which is not unusual and clinically unremarkable. Sometimes when I see that ‘divot’ in the \u00a0terminal part of the lead III QRS I wonder whether there is a superimposed P wave (these complexes look like many junctional or reentry rhythms with a buried retrograde P), but here that is not the case because the P waves are up front where they are supposed to be.<\/p>\n Where is the V lead placed? Usually folks place it smack in the middle which would show the septal (v1, v2) area.<\/p>\n The V lead has a positive P with a slightly positive net deflection, which would be normal around V3 or 4 in most patients. Also note that the T wave is upright in V which would not be expected in the septal region.<\/p>\n If you look closely it looks like there is PR segment depression in both leads, more obvious in III where the voltage gain is at 200%. This could be seen in pericarditis (although we don’t see concurrent ST elevations in either of these leads) or in atrial ischemia. It’s a subtle finding, however, likely nothing (possibly some artifact of the tele trace processing) and other leads would need to be evaluated.<\/p>\n Final Impression?<\/strong><\/p>\n Sinus rhythm @ ~85 bpm, possibly with nonspecific atrial repolarization abnormalities.<\/p>\n Management implications:<\/strong><\/p>\n Maybe a 12L to evaluate PR segments, or maybe not.<\/p>\n \u00a0The Take-home Point:<\/strong><\/p>\n PR segment depression is a pathologic finding. The true ‘baseline’ of the EKG is the flat segment before <\/em>the P wave, not after it, and I understand that PR depression and ST elevation should both be compared to the flat terminal QP segment as a reference.<\/p>\n <\/p>\n <\/p>\n sinus rhythm First Glance: From across the room it looks like sinus rhythm. Discussion: This looks like sinus rhythm, with a positive P in lead III (as expected) with flattened inverted T waves. The QRS complexes are narrow, with a hint of rSr’ in III which is not unusual and clinically unremarkable. Sometimes when I …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-562","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\/562","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=562"}],"version-history":[{"count":5,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/posts\/562\/revisions"}],"predecessor-version":[{"id":564,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/posts\/562\/revisions\/564"}],"wp:attachment":[{"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/media?parent=562"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/categories?post=562"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/tags?post=562"}],"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":"