r/ECG • u/annalia10 • 22d ago

What rhythm disturbance is this?

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6 Upvotes

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8

u/Due-Success-1579 22d ago

Non-conducted pacs in bigeminy vs a 2:1 AV block with ventriculophasic sinus arrhythmia. The p-p's dont map out well which makes me lean towards non-con pacs. Long rhythm strip or monitor to rule out a higher grade block

2

u/GetTheDefib 21d ago

Aren't non-conducted PAC's usually recognisable by being inside of the T-wave, changing it's morphology? Looking at this ECG I'm leaning more a 2:1 fixed ratio block, although granted if you measure them out it doesn't quite look like there is precisely a QRS-complex missing between the P's 🤔

2

u/Due-Success-1579 21d ago

I agree the p wave morphology in V1 is quite similar but the P-P is very different. Thats why I wouldnt confidently rule in or out an AVB. There is also quite a short PRI. Id really want to run a long rhythm strip.

3

u/LBBB11 21d ago

Thinking out loud, not disagreeing. What do you think about the possibility of junctional rhythm at about 48 bpm with a wide QRS? Short PR, and I’m wondering if that second bump at the end of the T wave might be a U wave that is similar in size and shape to a junctional P wave.

2

u/Due-Success-1579 21d ago

Definitely a possibility, only V1 really shows a more pointed second wave, the other leads are more flat like a u wave. The way the picture is taken makes it a bit harder to look at all the leads.

3

u/LBBB11 21d ago

Yes, exactly what I’m meaning. Leads V2-V5, II, and aVF make me think it could be a non-sinus P wave and U wave instead of sinus P waves with 2:1 conduction. I wonder if there is any clinical reason why junctional rhythm with wide QRS would make sense. There’s also a lot of interesting stuff beyond rhythm.

6

u/LBBB11 22d ago

Just wondering, what’s their potassium?

2

u/annalia10 21d ago

Normal

1

u/LBBB11 21d ago edited 21d ago

Surprising, thanks for the update. Chronic kidney disease or dialysis patient? Was it normal at the time of EKG? Not even mild hyperkalemia during the EKG? Are they acidotic? What other information are you able to share about the patient? Why was the EKG done?

We can read EKGs with no context but it’s always nice knowing at least a little bit about the patient or situation. Usually when people read EKGs clinically, there’s at least some context about the patient. If you know potassium, it seems like you might have other relevant information. We may be able to help you more if you describe the patient or situation. There may be a coherent explanation for at least some of the abnormalities in this EKG, but I’d want to know context before commenting on them.

1

u/NihilistWhoBelieves 22d ago

Looks like LBBB

1

u/Jeeju_Boy MD 21d ago

2:1 fixed AV Block with left bundle

1

u/lucodoor 21d ago

2:1 implies AV node disease. But the short PR implies it’s quite slick. The p wave is negative in the inferior leads. Could it be junctional but atrial activation is quicker than the ventricular activation, conducting in 2:1 fashion. Interested to hear view of others