ECG Guru - Instructor Resources

A gathering place for instructors of ECG and cardiac topics.

       

Subscribe to me on YouTube

ECG Basics: Accelerated Junctional Rhythm Overriding Normal Sinus Rhythm

Wed, 05/17/2017 - 15:01 -- Dawn

This strip shows a junctional rhythm at a rate of 110 beats per minute. The QRS complexes are slightly wide at .10 seconds (100 ms), and they are within the parameters for supraventricular rhythm. The term, "junctional tachycardia" could be used, also, but this is not likely a "reentrant" junctional tachycardia, which would be fast, regular, and have a sudden onset. That type of junctional tachycardia is a PSVT.   In this strip, we can see the underlying sinus rhythm in P waves that appear to pop up randomly.  However, if you march out the P waves, you will find that they are regular, at a rate of about 90 per minute.  The junctional rhythm has overrun the sinus rhythm.  Most of the P waves cannot conduct due to where they have landed - in the refractory period of the QRS.  The exception might be the P wave after the fifth QRS.  The sixth QRS might be conducted from that P wave.

When accelerated junctional rhythm is encountered, you should suspect DIGITALIS TOXICITY - the classic dysrhythmia associated with digitalis toxicity is accelerated junctional rhythm. Other causes in adults could be beta-agonist drugs such as adrenalin, cardiac infection, ischemia, or surgery.
 

Rate this content: 
No votes yet

All our content is FREE & COPYRIGHT FREE for non-commercial use

Please be courteous and leave any watermark or author attribution on content you reproduce.