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ECG Challenge donated by Guru member "chireu".

jer5150's picture

This is a derived (i.e., EASI) 12-lead ECG donated to the ECG Guru by new member "chireu".  The only history they were able to provide was one of possible atrial flutter but that was uncertain.  How would you interpret this ECG?

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Comments

Submitted by NYCMEDIC on

looks like complete HB  from lead II

with PJC's

 after printing the ecg, I can only see a sinus rythum rate about 60 with PJC possiby blocking the regular P wave..

Submitted by nthielke on

I am just starting to get the more advanced 12 Lead info. In this 12 lead I can see and march the P waves through leads II and III. Everyother one of them appears to have an asociated QRS complex. The rythm seems to be a cycle of 5 beats. The sinus beat, two wide early beats, then the sinus beat again and then what appears to be a PJC. The QRS beats asociated with the P waves can be marched out.

Nancy

Submitted by waltm on

Beat #1 = sinus beat


Beat #2 = interpolated PVC


Beat # 3 = sinus beat conducting with RBBB type aberrancy due to the lack of a pause from the interpolated PVC


Beat # 4 = sinus beat


Beat # 5 = junctional beat dissociated from the sinus P wave which follows the QRS


Then this bizarre sequence of beats repeats 2 more times.   I think.

Walter A. Mueller, CCT, CRAT

interesting tracing~~

sinus P waves can be seen marching as the baseline

the 1st and 4th QRS complex seem to be conducted from the sinus P

the 2nd QRS looks like a interpolated VPC, which does not interfere the sinus P wave from conducting but however causes prolonged unrefractory period

resulting in an aberrant conduction as seen in 3rd QRS

the 5th QRS might be a usurpassed junctional beat

the whole group repeats

just some guess

thank you!!

Submitted by zafer on

1.       A sinus p wave with right atrial enlargement followed by a premature junctional beat conducted with RBBB aberrancy and retrograde conduction to the atria.  The third complex is also conducted with RBBB aberrancy. The P wave of third complex is a fusion p wave (sinus + retrograde) and this third complex may be defined as a reciprocal beat.

2.       Sinus  beat (all sinus beats are conducted with first degree AV block)

3.       Junctional beat

4.       Sinus beat

5.       Premature junctional beat with RBBB aberrancy followed by a reciprocal beat

6.       Sinus beat

7.       Junctional beat

8.       Sinus beat

9.       Premature junctional beat with RBBB aberrancy

10.   Sinus beat (conducted sinus p distorts T wave)

And the tracing ends with:

11.   Sinus beat

12.   Junctional beat

In addition, I think the primary problem here is the accelerated Junctional rhythm which causes AV dissociation by usurpation and some of these junctional beats conducted aberrantly depending on their coupling interval with the sinus beats.  Thank you!

zafer karabulut

Sinus rhythm

Main-stem extrasystoles, some interpolated, tending to allorhythmia

Phasic aberrant conduction in both extrasystolic and sinus beats (following interpolation)

Non-spectific T wave changes

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