A weekly ECG / EKG review blog looking at some interesting ECG's from the world of Emergency Medicine.
Rhythm: sinus tachycardia at 120 bpm with a complete heart block and a junctional escape at 50 bpm. A rhythm strip would help determine if there were capture at any point, but I doubt it as the R-R remains very regular.Interpretation: Inferior wall myocardial infarction (ST-E II/III/aVF/V6, ST-D I/aVL) with possible posterior involvement (ST-D V2-V4). Likely proximal RCA occlusion (ST-E III > II).The efficacy of this patient's junctional rhythm is going to determine whether pacing gets utilized. I doubt atropine will help as it appears there is little vagal mediation of the sinus rate.
Christopher,I agree with the junctional escape...I am having trouble marching the P waves out to be regular sinus at 120 bpm...The last four P waves of the strip seem to do just that, but they don't seem to match those at the beginning of the strip. Thoughts?
Dave B,I noticed the same thing, they roughly marched out. Perhaps ventriculophasic sinus arrhythmia?