A weekly ECG / EKG review blog looking at some interesting ECG's from the world of Emergency Medicine.
Rate: 48Rhythm:2nd degree heart block with progressively prolonged pr interval before completely dropped beats. Axis: normalQT: normal rangeP waves inverted in leads V1 and V2 Interpretation 2nd degree heart block wenckebachCauses :MI –inferior B blocker Ca Channel blockers Digoxin Amiodarone MyocarditisLow risk of complete heat block, if asymptomatic no treatment needed. Symptomatically treat with atropine
Rate: atrial 70bpm, ventricular 50bpmRegularity: roughly regular irregularitiesP-waves: suspected sinusPRi: gradual prolongation until a dropped beat (4:3 and 3:2 association present)QRSd: narrowRhythm: sinus rhythm with 2AVB Type I (Wenckebach)Axis: normalQTc/QTi: normalST/T-waves: unremarkable, evidence of U-waves in V3-V5 which fuse with the P-wavesDDx: 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.)
INTERPRETATION: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. COMMENTS: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.
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
You inspired me at SMACC, so thought I would venture! Thanks
Hi Clare,Thank you. Hope you enjoy the blog, it's great to have new commenters on board.