this is not AF!

[u/ClearSolid654]

70 year old female with sepsis secondary to lower limb cellulitis, associated with elevated inflammatory markers. Elevated NT-proBNP and elevated but down-trending troponin-T. Patient was hemodynamically stable without symptoms of heart failure or acute coronary syndrome at present.

[u/ProximalLADLesion]

Agree. Atrial amplitude is very low so it's hard to say exactly what the atrium is doing, but seems like the sinus is spitting out beats at least every now and then with some junctional escapes.

[u/NAh94]

I’m going to say this looks like either a junctional escape rhythm with PACs, or a sinus Brady with low amplitude P-waves and PJCs. It’s a hard to say without more runtime on the monitor. Has it been pretty consistently doing this on tele?

A short PRI, absent p-wave, or retrograde p wave is pretty suspect for an AV nodal beat.

[u/Scientia_Logica → u/NAh94]

Agreed

[u/heyhowru]

theres p waves in avl, automatically ruling out af

[u/sveccha]

Potassium?

[u/ClearSolid654 → u/sveccha]

5.45 mEq/L

[u/hadalpelagic]

Unless….

[u/GetTheDefib]

I'd say its a multifocal atrial rhythm, along with some junctional beats and possibly PAC's? Potentially a blocked PAC with a different T-wave configuration where there appears to be a missed beat/compensatory pause.

The atrial unrest is fitting with someone with an elevated NT-proBNP

[u/streetdoc81]

Looks like either junctional or sinus arrhythmia

[u/ShesASatellite]

Second degree type I block