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.
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.
This ECG is from a 70 year old woman for which we have, unfortunately, no clinical information. It shows a sinus rhythm with a rate of about 72 bpm (NSR) with AV dissociation caused by third-degree heart block. The escape rhythm is junctional at a rate of 38 bpm. There appears to be a right bundle branch block, based on the QRS duration of 132 ms, and a wide S wave in Leads I and V6. The precordial leads do not show the usual RBBB pattern of rSR' in V1 and V2, and the r wave progression is poor (non-existent). This is felt to be due to poor lead placement (a go
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