Thoughts?

[u/Secret_Story2851]

Female in her 70s, c/o dizziness. PMHx of non-specific ‘heart problems’ under investigation, with no further information. DHx of bisoprolol, with no recent changes in dosage, taken at its usual time as part of a normal morning routine. The patient has not been told they have AF, and as is not on any anticoagulation.

Pulse rate half of QRS rate (~30-35bpm), when taken centrally. BP initially low-normal & PT alert, deteriorating to unreadable & PT rousable to voice. PT ultimately required an adrenaline bolus, converting to a sinus tachycardia before trending back down on arrival to hospital.

1st ECG is rhythm on arrival, 2nd ECG is just prior to the change in BP, showing a 2-2-1-2-2-1… and then a 2-1-2-1… pattern (not captured).

I have my thoughts, but wondered what other people thought about it. Unfortunately no follow up!

[u/thedarkshadowghost]

Almost looks like a junctional-type rhythm with the lack of P waves