Friday, 29 March 2013

ECG of the Week - 1st April 2013

Sorry, I don't have any clinical information on this one.

Click to enlarge


  1. Rate: 48

    Rhythm:2nd degree heart block with progressively prolonged pr interval before completely dropped beats.

    Axis: normal

    QT: normal range

    P waves inverted in leads V1 and V2
    Interpretation 2nd degree heart block wenckebach

    Causes :MI –inferior
    B blocker
    Ca Channel blockers

    Low risk of complete heat block, if asymptomatic no treatment needed. Symptomatically treat with atropine

  2. Rate: atrial 70bpm, ventricular 50bpm
    Regularity: roughly regular irregularities
    P-waves: suspected sinus
    PRi: gradual prolongation until a dropped beat (4:3 and 3:2 association present)
    QRSd: narrow
    Rhythm: sinus rhythm with 2AVB Type I (Wenckebach)
    Axis: normal
    QTc/QTi: normal
    ST/T-waves: unremarkable, evidence of U-waves in V3-V5 which fuse with the P-waves

    DDx: uncomplicated AV Wenckebach, which likely is causing no hemodynamic insult as there is no compensatory tachycardia from the sinus node. All intervals and waves appear relatively normal, no evidence of electrolyte or drug toxicities, no evidence of ischemia or infarction. Some relatively higher voltages in the limb leads and precordials with septal-Q's point to "athlete's heart" as a possible cause with high vagal tone inducing Wenckebach. AVN disease and structural abnormalities seem less likely given the fairly unremarkable ECG otherwise.

    (Also, happy to see new folks posting! I wish more folks would take advantage of this wonderful resource.)


    1. Sinus rhythm (rate about 65/min) with . . .
    2. . . . Type I A-V block manifest in the form of . . .
    3. . . . 3:2 and 4:3 Wenckebach periods.


    In addition to the presence of R-P/P-R reciprocity, all 3 of the "Footprints of the Wenckebach" are present as well:
    (1.) Small "groups" of beats; e.g., at least one trio and one pair,
    (2.) During the 4:3 Wenckebach period, there is progressive shortening of the RR interval, and
    (3.) The longest RR interval (encompassing the "dropped" beat) is less than twice the shortest RR interval.

  4. Hi guys,

    Just wanted to welcome Clare to the blog commenting team :-)

    A nod as always to Jason and Christopher for their excellent comments/thoughts on our ECGs.

    John L

  5. You inspired me at SMACC, so thought I would venture! Thanks

  6. Hi Clare,

    Thank you.

    Hope you enjoy the blog, it's great to have new commenters on board.