This strip shows the onset of atrial fibrillation. A fib can be "paroxysmal," meaning that it has a sudden onset, but then stops spontaneously, usually within 24 hours to a week. A fib can also be classified as "persistent", meaninging that the a fib lasts more than a week. It can stop spontaneously, or be halted with medical treatment. "Permanent" a fib is a fib that is resistent to treatment.
A paramedic crew responded to the office of a local physician. A 61-year-old male presented with a one-week history of chest pain and shortness of breath.
This is an interesting teaching ECG on many levels. It is obtained from a man with chest pain. No other history or follow up is available.
This ECG rhythm strip has all the hallmarks of atrial fibrillation: the rhythm is irregularly irregular and there are no P waves. The rate is about 150 beats per minute. There is no P wave because the atria are being irregularly depolarized by many ectopic pacemakers at once, causing the atria to "quiver". This patient has new-onset atrial fib, and has been medicated with a calcium channel blocker. The rate shows signs of slowing, but has not reached the target rate for this patient of less than 80 bpm.
This rhythm strip is recorded in two simultaneous leads, which is always preferable to one single lead. It is a good example of atrial fibrillation with a rapid ventricular response. Atrial fib that has not been treated will usually have a rapid ventricular rate. This reflects the ability of the AV node to conduct a tachycardia, within limits. The natural slow conduction of the AV node allows it to act as a "filter", preventing the huge numbers of impulses generated by the atrial fibrillation from reaching the ventricles.
This patient was diagnosed by the rescue crew as having atrial fibrillation, based on the fact that they thought the rhythm was irregular, and they could not see P waves. They also noted a wavy baseline, and considered it to be fibrillatory waves. In reality, the underlying rhythm is regular, with some PACs (regularly irregular).
This patient has an underlying atrial fibrillation with complete heart block and an idioventricular escape rhythm. She was treated successfully with a permanent implanted pacemaker.
This 31-year-old man presented to the Emergency Dept. complaining of chest pain, shortness of breath, and nausea. His heart rate on admission was 120 - 130 bpm and irregular, and the monitor showed atrial fibrillation. His rate slowed with the administration of diltiazem. His 12-lead ECG shows the classic ST elevation of inferior wall M.I. in Leads II, III, and aVF.
This series of strips was donated by Arnel Carmona, and was taken from a patient admitted to the hospital for a urinary tract infection. No other history is known. On close examination of this rhythm what do we see?
Strip 1: Narrow-complex tachycardia with NO apparent P waves.
Strip 2: Some irregularity, with long regular groups and still NO P waves.
This very interesting set of strips was donated to the ECG Guru by Arnel Carmona, well-known to many of you as the Administrator of the blog, "ECG Rhythms" and the FB page by the same name. He is a frequent contributer to the FB page, "EKG Club", and is an ECG Guru! This set of strips was previously posted to his blog and to the EKG Club.
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