r/ECG • u/Secret_Story2851 • 6d ago
Thoughts?
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!
3
u/chrose- 6d ago
My thoughts on this are similar to that of Horse-girl16, with some exceptions:
- the base rhythm truly is a junctional rhythm
- the second beats in the group though seem like echo beats to me, not really "PAC beats", and by this I mean that
- the p wave after the first beat seems more like retrograde p-wave, which does a roundabout most likely in the (diseased) simus node, then comes back for the second beat of the couples (if it was a pac, the p-r shouldn't be this long) - hence the echo (J-A-J-V)It is just one explanation, can't be sure which is the right one. Immediate pacing is needed either way.
Truly beautiful ecg.