Can't believe I was able to comment on this before Mr. Watford! Must have gotten sidetracked by the new engagement. :)
INTERPRETATION: Atrial flutter (rate about 286/min) with varying A-V conduction (mostly 2:1) spontaneously terminates. Assuming the two rhythm tracings are continuous, there is a greater than 5 second period of asystole. There is an extremely poor Sinus Node Recovery Time (SNRT) and a complete absence of any escape mechanisms. This may be a manifestation of sick sinus syndrome (e.g., brady-tachy syndrome) however the sinus rate is more than adequate once the sinus node resumes discharging. The sinus rhythm starts out at 70/min and quickly warms-up to a steady rate of 80/min.
As Jason guessed, dinner with the future mother-in-law provided an opening! It is fitting that Jason beat me to this though, as he is a true rhythm ninja :)
I too agree that it looks like flutter with 2:1 (and a bit of 3:1) conduction in the upper strip followed by atrial and ventricular standstill of about 4.6s, which is bizarre as Jason noted given the more than adequate sinus rate in the lower strip.
Tachy-brady wasn't the first that came to mind, but certainly is on the list. I wondered if some outside stimulus (medicine not Edison) wasn't applied at that time point?
Can't believe I was able to comment on this before Mr. Watford! Must have gotten sidetracked by the new engagement. :)
ReplyDeleteINTERPRETATION:
Atrial flutter (rate about 286/min) with varying A-V conduction (mostly 2:1) spontaneously terminates. Assuming the two rhythm tracings are continuous, there is a greater than 5 second period of asystole. There is an extremely poor Sinus Node Recovery Time (SNRT) and a complete absence of any escape mechanisms. This may be a manifestation of sick sinus syndrome (e.g., brady-tachy syndrome) however the sinus rate is more than adequate once the sinus node resumes discharging. The sinus rhythm starts out at 70/min and quickly warms-up to a steady rate of 80/min.
Hi Jason,
ReplyDeleteGood to hear from you, I hope you had an enjoyable Christmas period.
I should really set up a prize for anyone who can comment before Christopher ;-)
Thanks,
John
As Jason guessed, dinner with the future mother-in-law provided an opening! It is fitting that Jason beat me to this though, as he is a true rhythm ninja :)
ReplyDeleteI too agree that it looks like flutter with 2:1 (and a bit of 3:1) conduction in the upper strip followed by atrial and ventricular standstill of about 4.6s, which is bizarre as Jason noted given the more than adequate sinus rate in the lower strip.
Tachy-brady wasn't the first that came to mind, but certainly is on the list. I wondered if some outside stimulus (medicine not Edison) wasn't applied at that time point?
Neat strip!
Hmmm. What about multifocal atrial tachycardia?
ReplyDelete