\n
![\"\"](\"http:\/\/electricant.net\/ekg\/striptease\/strip65.jpg\")
<\/a><\/p>\nFirst Glance:<\/strong><\/p>\n From across the room it looks like an irregularly irregular narrow complex rhythm on the slow side.<\/p>\n Discussion:<\/strong><\/p>\n We can’t really make much out of the baseline here. It looks fibrillatory, but I’d jack the gain up before I felt secure about it. In a few spots it does look a little tiny bit like some flutter waves might be showing throguh.<\/p>\n The QRS complexes are identical and narrow, and at irregular intervals. This looks like atrial fibrillation, but this same strip could be generated by an atrial rhythm with variable block, wandering pacemaker, a sick sinus node, etc. I doubt it is flutter with a variable block, because there really isn’t a single RR interval which is the same on this strip, and flutter with variable block would generally randomly (or non-randomly) tend to repeat certain RR intervals.<\/p>\n Final Impression?<\/strong><\/p>\n Irregularly irregular supraventricular rhythm @ 60 bpm, likely afib.<\/p>\n Management implications:<\/strong><\/p>\n Identify the rhythm. This is on the slow side, so if the patient is hemodynamically compromised it is possible that reducing a rate control drug or increasing her sympathetic tone might shorten the pauses and increase the cardiac output.<\/p>\n <\/p>\n \u00a0The Take-home Point:<\/strong><\/p>\n How do you count a heartrate in a strip like this? I count 3 second boxes. Here you can see subtle vertical hash-marks along the upper line of the grid which are the standard 3 seconds apart. I count 9 beats in 3 boxes = 9 beat in 9 seconds = 1 beat in 1 second (average) = average 60 bpm.<\/p>\n If you have an irregularly irregular rhythm, the more boxes you count, the more accurate it is.<\/p>\n <\/p>\n ?afib First Glance: From across the room it looks like an irregularly irregular narrow complex rhythm on the slow side. Discussion: We can’t really make much out of the baseline here. It looks fibrillatory, but I’d jack the gain up before I felt secure about it. In a few spots it does look a little …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":[3],"class_list":["post-697","post","type-post","status-publish","format-standard","hentry","category-cases","tag-2star"],"_links":{"self":[{"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/posts\/697","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=697"}],"version-history":[{"count":5,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/posts\/697\/revisions"}],"predecessor-version":[{"id":698,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/posts\/697\/revisions\/698"}],"wp:attachment":[{"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/media?parent=697"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/categories?post=697"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.electricant.net\/ekg\/wp-json\/wp\/v2\/tags?post=697"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}<\/a>Two star strip. The meat and potatoes.<\/em><\/p>\n—> see the next strip<\/a><\/h1>\n","protected":false},"excerpt":{"rendered":"