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Complete AV Block With Junctional Escape Rhythm

Thu, 09/03/2015 - 23:02 -- Dawn

This ECG was taken from a 90-year-old woman.  We have no other history, unfortunately.  It is a good example of a sinus rhythm with complete AV block, also called third-degree AV block.

The defining characteristics of this rhythm include:   1) an underlying rhythm that is regular and with a physiological rate.  In other words, the P waves are not so fast that they would not be expected to conduct one-to-one.  2)  a second rhythm of regular QRS complexes that is unrelated to the P waves.

Complete AV Block

Tue, 09/16/2014 - 14:26 -- Dawn

This ECG is from an 84-year-old man who experienced dizziness and a fall.  He was not injured in the fall.  In this ECG, we can clearly see regular P waves at about 110 per minute.  We also see wide QRS complexes at about 52 per minute.  There is AV  dissociation - there are no regular PR intervals, or even progressively-prolonging PR intervals.  The atrial and the ventricles are beating to separate rhythms.  What is interesting about this rhythm is the origin of the escape rhythm.

Inferior Wall M.I. With Junctional Rhythm

Fri, 01/10/2014 - 15:07 -- Dawn

We do not have a patient history for this ECG, other than that it was an 81-year-old woman with chest pain.  The classic signs of acute ST-elevation inferior wall M.I. are there:  ST segment elevations in Leads II, III, and aVF.  There are the expected reciprocal ST depressions in Leads I and aVL.   The ST depression in V2 suggests posterior wall injury, and would normally be seen in V1 as well, unless something else is causing ST elevation in V1 at the same time.

ECG Basics: Idioventricular Escape Rhythm

Tue, 11/12/2013 - 14:38 -- Dawn

This six-second monitor strip was from a patient who was designated "Do Not Resuscitate", and whose heart rhythm was slowing dramatically.  It shows an idioventricular escape rhythm, with very wide QRS complexes and only two complexes in six seconds. (The top arrows mark three-second segments.)  If you look closely at the points marked by the lower arrows, you will see small, uniform, regular P waves.  The mechanism leading to this agonal rhythm was complete heart block.  A longer strip would show the P waves as all alike, and fairly regular, but slowing.  

Complete Heart Block

Sat, 04/27/2013 - 21:38 -- Dawn

This week's ECG of the WEEK was donated to us by Sebastian Garay. These two ECGs were obtained less than 30 seconds apart from an 84 year-old man who called fire-rescue because he felt dizzy and fell.  He was not injured in the fall, and his vital signs remained stable, with an adequate BP.  These two ECGs were obtained prior to arrival in the Emergency Dept.

Inferior Wall M.I. With Third-degree AV Block

Thu, 11/15/2012 - 23:15 -- Dawn

This ECG was obtained from an elderly woman who suffered a complete right coronary artery occlusion and inferior wall M.I.  In her case, the AV node was also affected, and she developed a third-degree AV block with a junctional escape rhythm.  A good ECG for ACLS classes as well as for ECG classes.  A lively discussion can be had regarding "types" of complete heart block and the nature of the escape rhythm - when to treat and when to leave the rhythm alone.

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