ECG Guru - Instructor Resources - Atrial pacing https://www.ecgguru.com/ecg/atrial-pacing en Acute M.I. With Right Bundle Branch Block and Atrial Pacing https://www.ecgguru.com/ecg/acute-mi-right-bundle-branch-block-and-atrial-pacing <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/acute-mi-right-bundle-branch-block-and-atrial-pacing"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/12%20lead%201000%20am.jpg" width="1800" height="716" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">This ECG was taken from a 78-year-old man who was experiencing chest pressure in the morning, after having left shoulder pain since the night before. He has a history of hypertension and hypercholesterolemia, and has an implanted pacemaker. </span></p><p class="MsoNormal" style="line-height: normal;"><strong><span style="font-size: 12.0pt; color: #00b050;">What does the ECG show?&nbsp; </span></strong><span style="font-size: 12.0pt;">The ECG shows an <strong>atrial paced rhythm</strong>, with two premature beats, beats number 5 and 12.&nbsp; These are probably PVCs.&nbsp; The patient has a functioning AV conduction system, so the paced atrial beats are conducting through the AV node and producing QRS complexes.&nbsp; In the interventricular conduction system, the impulse encounters <strong>right bundle branch block. </strong>This causes each QRS to have an “extra” wave attached at the end, representing slightly delayed depolarization of the right ventricle.&nbsp; Instead of an “rS” pattern in V1, for example, we see “rSR’ “.&nbsp; The slight delay causes the QRS to be widened, as we are measuring the two ventricles separately, rather than synchronously.</span></p><p class="MsoNormal" style="line-height: normal;"><span style="font-size: 12.0pt;">There is <strong>definite</strong> <strong>ST segment elevation</strong> in V<sub>2</sub> and V<sub>3</sub>, and the shape of the ST segment is straight, having lost it’s normal “concave upward” appearance.&nbsp; In an ECG taken three minutes later, the STE extends to V<sub>4</sub>.</span></p><p class="MsoNormal" style="line-height: normal;"><strong><span style="font-size: 12.0pt; color: #00b050;">Do the pacemaker or the right bundle branch block prevent us from diagnosing an ST-elevation M.I.?</span></strong><strong><span style="font-size: 12.0pt;">&nbsp; </span></strong><span style="font-size: 12.0pt;">The answer to that is a resounding <strong>“NO!” </strong>Pacemakers can sometimes make it difficult to assess ST elevation because ventricular pacing causes ST segment changes.&nbsp; Pacing the right ventricle causes a depolarization delay in the left ventricle as the impulse travels “cell to cell” across the LV.&nbsp; This means an RV-paced beat will resemble a PVC from the RV.&nbsp; When LV depolarization is altered, repolarization will also be altered, causing <em>ST elevation in leads with negative QRS</em> <em>complexes,</em> and <em>ST depression is leads with upright QRSs</em>. These are called <strong>discordant ST</strong> <strong>changes</strong>. These changes are proportionate to the height or depth of the QRS, with very minimal or no ST changes in leads with short or biphasic QRS complexes.&nbsp; We don’t have to worry about that in this situation – the pacemaker is <em>not pacing the ventricles.</em></span></p><p class="MsoNormal" style="line-height: normal;"><span style="font-size: 12.0pt;">You might have heard that bundle branch block makes it hard or even impossible to diagnose STEMI.&nbsp; <strong>Left bundle branch block </strong>can cause some difficulty because, in LBBB, the left ventricle is depolarized via the right ventricle, instead of via the left bundle branch.&nbsp; Like in RV pacing, the slow, cell-to-cell depolarization that results from LBBB also causes ST changes that are <strong>discordant</strong> to the QRS complexes, and proportionate to the size of the QRSs.&nbsp; </span></p><p class="MsoNormal" style="line-height: normal;"><span style="font-size: 12.0pt;">But this patient has <strong>right bundle branch block</strong>. The left ventricle is depolarizing (and repolarizing) normally, while the conduction delay is in the right ventricle.&nbsp; Since the M.I. is in the left ventricle, these obvious ST elevations indicate <strong>acute STEMI</strong>.</span></p><p>&nbsp;</p><p class="MsoNormal" style="line-height: normal;"><strong><span style="font-size: 12.0pt; color: #00b050;">Patient outcome.&nbsp; </span></strong><span style="font-size: 12.0pt;">The EMS crew called the hospital with a “STEMI Alert”. &nbsp;A second ECG showed increasing STE. &nbsp;The patient’s troponin level was 0.33 ng/mL in the Emergency Dept. (Normal troponin is less than 0.01 ng/mL). He was rushed to the cath lab, where an occlusion was found in his left anterior descending artery.&nbsp; The artery was opened and stented successfully.</span></p><p class="MsoNormal" style="line-height: normal;"><span style="font-size: 12.0pt;">Thanks to Lew Steinberg, Ryan Winkelman, and Palm Beach Gardens Fire Rescue for this interesting tracing.&nbsp;</span></p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/88/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Acute M.I. With Right Bundle Branch Block and Atrial Pacing 1/5</option><option value="40">Give Acute M.I. With Right Bundle Branch Block and Atrial Pacing 2/5</option><option value="60">Give Acute M.I. With Right Bundle Branch Block and Atrial Pacing 3/5</option><option value="80">Give Acute M.I. With Right Bundle Branch Block and Atrial Pacing 4/5</option><option value="100" selected="selected">Give Acute M.I. With Right Bundle Branch Block and Atrial Pacing 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.3</span></span> <span class="total-votes">(<span >4</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-_J_ZdrE6-05TdsNLpPtaTZdkuMYbo_TUEg_0CLoi7SI" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/anterior-mi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Anterior M.I.</a></div><div class="field-item odd"><a href="/ecg/right-bundle-branch-block-1" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Right bundle branch block</a></div><div class="field-item even"><a href="/ecg/rbbb" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">RBBB</a></div><div class="field-item odd"><a href="/ecg/atrial-pacing" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial pacing</a></div><div class="field-item even"><a href="/ecg/st-elevation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ST elevation</a></div><div class="field-item odd"><a href="/ecg/stemi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">STEMI</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Facute-mi-right-bundle-branch-block-and-atrial-pacing&amp;title=%20Acute%20M.I.%20With%20Right%20Bundle%20Branch%20Block%20and%20Atrial%20Pacing"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Thu, 25 Jan 2018 04:08:48 +0000 Dawn 752 at https://www.ecgguru.com https://www.ecgguru.com/ecg/acute-mi-right-bundle-branch-block-and-atrial-pacing#comments Atrial Pacing With Right Bundle Branch Block https://www.ecgguru.com/ecg/atrial-pacing-right-bundle-branch-block <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/atrial-pacing-right-bundle-branch-block"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/PM109%20%20Atrial%20pacing%20with%20RBBB.jpg" width="1800" height="1092" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>No instructor's collection should be without an atrial paced rhythm OR a right bundle branch block. &nbsp;Here, you get both. &nbsp;First, the atrial pacing. &nbsp;This patient had a sinus node problem, but his AV conduction system was functional (if not perfect). &nbsp;At this time, he is able to conduct impulses from the atria to the ventricles. &nbsp;What he cannot do is reliably produce the impulse in his atria. &nbsp; So, this pacemaker is currently pacing the right atrium, producing a paced "P" wave, which is then conducted to the ventricles. &nbsp;The fifth beat on the strip shows a "native" beat - one produced by the patient. &nbsp;No P wave is seen, so it is presumed to be a junctional beat.</p><p>As for conduction through the ventricles, there is a right bundle branch block. &nbsp;The left bundle branch is ensuring that the ventricles receive the depolarization "message", and the ventricles are depolarizing and contracting. &nbsp;However, the right ventricle gets the message a little late, since is arrives from the left ventricle, and not through a functioning right bundle branch. &nbsp;This produces a terminal wave on each QRS that represents this delayed depolarization of the right ventricle. &nbsp;In leads oriented to the left side of the heart, like I and V6, it is seen as a wide little S wave. &nbsp;In V1, which is oriented to the patient's right, we see an R prime (R'), producing the easily-recognizable rSR' pattern of RBBB.</p><p>For your more advanced students, this patient has atypical T waves for RBBB. &nbsp;Normally, the T waves axes should be OPPOSITE that of the terminal portion of the QRS. &nbsp;So, Lead V1 correctly shows an inverted T wave, since the R' is a positive deflection. &nbsp;There are inverted T waves in Leads III, aVF (II is biphasic), as well as in V4, V5, and V6. &nbsp;We expected upright T waves here. Because we do not have clinical information for this patient, we will call them "non-specific" T wave changes, remembering that inverted T waves can be a sign of ischemia.</p><p>ALSO: &nbsp;As noted in Dave Richley's comment below, there is a left axis deviation, with a negative Leads II, aVF and III, and a positive I and aVL. &nbsp;This &nbsp;indicates left anterior fascicular block, which is rather common with RBBB, since the right bundle branch and the left anterior fascicle share a blood supply. So, this person as a "bi-fascicular block".&nbsp;</p><p>&nbsp;</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/88/feed" method="post" id="fivestar-custom-widget--2" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--4" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Atrial Pacing With Right Bundle Branch Block 1/5</option><option value="40">Give Atrial Pacing With Right Bundle Branch Block 2/5</option><option value="60">Give Atrial Pacing With Right Bundle Branch Block 3/5</option><option value="80">Give Atrial Pacing With Right Bundle Branch Block 4/5</option><option value="100" selected="selected">Give Atrial Pacing With Right Bundle Branch Block 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.3</span></span> <span class="total-votes">(<span >3</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--2" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-ux5qAlKeYFSBv8XmFen1OYsDAlX_yYvIdtiyxsKrpvI" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/pacemaker" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pacemaker</a></div><div class="field-item odd"><a href="/ecg/atrial-pacing" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial pacing</a></div><div class="field-item even"><a href="/ecg/paced-rhythm" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Paced rhythm</a></div><div class="field-item odd"><a href="/ecg/right-bundle-branch-block-1" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Right bundle branch block</a></div><div class="field-item even"><a href="/ecg/rbbb" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">RBBB</a></div><div class="field-item odd"><a href="/ecg/bundle-branch-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Bundle branch block</a></div><div class="field-item even"><a href="/ecg/left-anterior-fascicular-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left anterior fascicular block</a></div><div class="field-item odd"><a href="/ecg/hemiblock" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Hemiblock</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_2"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fatrial-pacing-right-bundle-branch-block&amp;title=Atrial%20Pacing%20With%20Right%20Bundle%20Branch%20Block"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Mon, 19 May 2014 18:32:22 +0000 Dawn 575 at https://www.ecgguru.com https://www.ecgguru.com/ecg/atrial-pacing-right-bundle-branch-block#comments ECG Basics: Atrial Pacing https://www.ecgguru.com/ecg/basic-ecg-week-june-21-2013-atrial-pacing-0 <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/basic-ecg-week-june-21-2013-atrial-pacing-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/106%20Atrial%20Pacing_0.jpg" width="1800" height="299" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This strip for your basic students is a nice example of atrial pacing in a patient with an intact interventricular conduction system. &nbsp;Generally, the pacemaker will behave this way when the sinus node is not functioning well enough to provide adequate rate for the patient, and the conduction system from the AV node down is functioning properly.</p><p>Pacemakers in the modern age are very complicated to understand for the beginner, and pacemaker programming and malfunctions often cannot be determined from a simple rhythm strip. &nbsp;It can be a challenge to teach beginning students about the programming options available today. &nbsp;This strip is nice because it is clear, and the pacer spikes are readily seen. &nbsp;The patient is being paced 100% of the time in this strip.</p><p>&nbsp;</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/88/feed" method="post" id="fivestar-custom-widget--3" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--6" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give ECG Basics: Atrial Pacing 1/5</option><option value="40">Give ECG Basics: Atrial Pacing 2/5</option><option value="60">Give ECG Basics: Atrial Pacing 3/5</option><option value="80" selected="selected">Give ECG Basics: Atrial Pacing 4/5</option><option value="100">Give ECG Basics: Atrial Pacing 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.8</span></span> <span class="total-votes">(<span >4</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--3" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-pMEo9nD0Rky1damMtSLlfo4rVpcbfwo1dr_5d-0duZg" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/atrial-pacemaker" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial pacemaker</a></div><div class="field-item odd"><a href="/ecg/atrial-pacing" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial pacing</a></div><div class="field-item even"><a href="/ecg/ecg-basics" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ECG Basics</a></div><div class="field-item odd"><a href="/ecg/basic-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Basic ECG</a></div><div class="field-item even"><a href="/ecg/rhythm-strip" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Rhythm strip</a></div><div class="field-item odd"><a href="/ecg/pacemaker" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pacemaker</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_3"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fbasic-ecg-week-june-21-2013-atrial-pacing-0&amp;title=ECG%20Basics%3A%20%20Atrial%20Pacing"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Fri, 21 Jun 2013 04:37:39 +0000 Dawn 458 at https://www.ecgguru.com https://www.ecgguru.com/ecg/basic-ecg-week-june-21-2013-atrial-pacing-0#comments Atrial Pacing in a Patient With Acute Inferior Wall M.I. https://www.ecgguru.com/ecg/atrial-pacing-patient-acute-inferior-wall-mi <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/atrial-pacing-patient-acute-inferior-wall-mi"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/PM%20107.png" width="1800" height="1036" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>Some people have been taught (incorrectly) that an electronic pacemaker prevents us from seeing an acute ST elevation M.I.&nbsp; Not true.&nbsp; It can be difficult to interpret ST elevation <a title="Paced rhythm with acute M.I." href="http://www.ekgguru.com/paced-rhythm-with-acute-anterior-lateral-m-i">M.I. in the setting of WIDE QRS complexes</a>.&nbsp; When this situation exists, it is best left to the experienced ECG interpreter to determine whether there is STEMI.&nbsp; In this ECG, we see ATRIAL pacing.&nbsp; The patient has an intact AV conduction system.&nbsp; The pacemaker paces the atria, and the impulse continues normally through the AV node and the ventricles.&nbsp; The QRS that results is normal (narrow).&nbsp; In this situation, the ST segments are accurate for determining ST elevation and depression.</p> <p>This patient is a 74-year-old man who complained of chest pain for five days before presenting to his primary physician at&nbsp;the outpatient clinic.&nbsp; After obtaining this ECG, the PCP&nbsp;transferred his patient to the Emergency Department.&nbsp; He was admitted to the CCU with troponin level of 2.13 ng/ML. (Normal &lt; 1.5 ML)</p> <p>&nbsp;</p> <p><strong>Our thanks to Jason Roediger, ECG GURU, for contributing this ECG.</strong></p> <p>&nbsp;</p> </div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/88/feed" method="post" id="fivestar-custom-widget--4" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--8" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Atrial Pacing in a Patient With Acute Inferior Wall M.I. 1/5</option><option value="40">Give Atrial Pacing in a Patient With Acute Inferior Wall M.I. 2/5</option><option value="60">Give Atrial Pacing in a Patient With Acute Inferior Wall M.I. 3/5</option><option value="80" selected="selected">Give Atrial Pacing in a Patient With Acute Inferior Wall M.I. 4/5</option><option value="100">Give Atrial Pacing in a Patient With Acute Inferior Wall M.I. 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4</span></span> <span class="total-votes">(<span >7</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--4" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-yrQ_C5Glq9HzegkrSVi84E1LbnWxmIrzgA38mapnGyg" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/atrial-pacing" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial pacing</a></div><div class="field-item odd"><a href="/ecg/pacemaker" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pacemaker</a></div><div class="field-item even"><a href="/ecg/inferior-wall-mi-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Inferior Wall M.I.</a></div><div class="field-item odd"><a href="/ecg/st-elevation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ST elevation</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_4"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fatrial-pacing-patient-acute-inferior-wall-mi&amp;title=Atrial%20Pacing%20in%20a%20Patient%20With%20Acute%20Inferior%20Wall%20M.I."><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Mon, 23 Jul 2012 02:23:44 +0000 Dawn 254 at https://www.ecgguru.com https://www.ecgguru.com/ecg/atrial-pacing-patient-acute-inferior-wall-mi#comments