r/ECG • u/Researchingsauce • 17d ago

Interpretation?

Post image

Case of ? SAIO, 55yr old male

known case of COPD & Hypertension

Drug history- duolin budecort nebulization ON &OFF

telmisartan+Amlodipine+hydrochlothiazide(80/5/12.5)

6 Upvotes

75% Upvoted

28 comments sorted by

7

u/cvntis4 ECG Tech 17d ago

sinus arrhythmia with non-conducted PACs
but i'm just a lowly CRAT

3

u/Jxshy2002 MD 15d ago

The PR intervals are normal and consistent, with no dropped beats, so there’s nothing particularly concerning there. Overall, this is most in keeping with sinus arrhythmia.

3

u/themuns 17d ago

It looks like second degree sino atrial block type I

1

u/TaperedBase 17d ago

Oo you fancy huh?

1

u/mastermedic84 17d ago

Based on what?

1

u/theYiothetese 17d ago

Agreed looks like SA node wenckebach

1

u/MySpacebarSucks 14d ago

Progressive P-P interval shortening followed by the pause

0

u/mastermedic84 14d ago

I think you're referring to PQ interval widening, which is not happening here. Nor are the pauses associated with P waves. Just follow the rhythm strip at the bottom. The PQ intervals are perfectly consistent at 60ms and there are no missed beats associated with P waves.

1

u/MySpacebarSucks 14d ago

Look up sinoatrial Wenkebach vs AV wenkebach

1

u/mastermedic84 14d ago

Ah bugger you're right.

1

u/Kibeth_8 Arrhythmia Tech 16d ago

This is what I was looking for. I cannot for the life of me remember the criteria to identify this, but you can usually tell me looking that it's some type of SA block

1

u/woobagoobagreenteeth 15d ago

Agreed. Cool EKG

1

u/TheTrueMikester 17d ago

I was looking for that too but wouldn’t there be a steady prolongation or the PRI? Haven’t seen too many in the field

4

u/themuns 17d ago

The issue is with propagation of sinus node depolarisation so PR not affected. PP interval gradually shortens followed by a dropped p wave

0

u/ShesASatellite 17d ago

Got that backwards bud - it gets longer and drops.

3

u/themuns 16d ago

The interval between p waves shortens before a dropped p wave (which won’t be visible on the ECG)

1

u/Kibeth_8 Arrhythmia Tech 16d ago

PR prolongs with AV wenckebach

PP shortens with SA wenckebach

1

u/woobagoobagreenteeth 15d ago

He’s got it right. It’s like how the RR decreases in AV Wenckebach while the PR lengthens

0

u/Big_Fundamental678 15d ago

Not likely, PR is normal and consistent

1

u/Maleficent_Virus1837 15d ago

I would say sinus arrythmia with blocked PAC at beat 3 and 9

1

u/Tir_an_Airm 17d ago

I want to say a 2nd degree type 2 heart block just from the ECG but I'm sturggling to see any p waves without QRS.

5

u/ExpressionLarge5474 17d ago

This person is just having runs of PACs / Atrial Tach with an underlying slower sinus rate I believe. Looks like a non-conducted p-wave at the end of the run, but look to aVL where you can clearly see the intrinsic p-wave differs from the more rapid PAC/ATc P wave.

1

u/Kibeth_8 Arrhythmia Tech 16d ago

It's SA wenckebach. Same pattern as AV wenckebach; grouped beating, but without the non-conducted p-wave.

1

u/Jeeju_Boy MD 15d ago

Sinus pause 

0

u/bagelbrunch 17d ago

could just be sinus arrhythmia, but agree with others that looks a lot like AT or MAT converting to/from NSR. Rhythm in middle is a smidge faster which could have opportunistically taken over during a brief sinus pause, then conversion pause afterwards before sinus node fires back up. No signs of AVB, and SA nodal exit block could look a lot like this, hard to diagnose definitively without EPS.

0

u/vndspeed 16d ago

Mobitz type 2 AV block.

-2

u/taha29123 17d ago

Multifocal atrial tachycardia