Submitted by Dr A Röschl on Mon, 02/10/2025 - 02:22
AV blocks are among the ECGs that are particularly difficult to diagnose and where the most mistakes are made.
Here is the ECG of a 75-year-old lady who has not been feeling well for the last few weeks and is complaining of shortness of breath on exertion.
The ECG is irregular with alternating smaller and larger RR intervals.
QRS 2, 4 and 6 each show the same PR interval; it can be assumed that these are sinus node beats that are conducted.
QRS 1, 3, 5, 7 are junctional escape beats without reference to the P waves.
Submitted by Dr A Röschl on Fri, 01/03/2025 - 03:32
This ECG is from a 65-year-old woman who had previously had no cardiac abnormalities but has now suffered several syncopes within 2 weeks. During the last syncope she suffered a fracture of the left femur.
Submitted by Dr A Röschl on Mon, 11/20/2023 - 03:40
Let's analyze the ECG. It comes from a pacemaker patient whose pacemaker was briefly switched to VVI at 30 bpm due to a stimulation threshold test. The first 3 beats show a sinus rhythm with a frequency of approx. 40 bpm. This is followed by a premature ventricular contraction (PVC). The P wave of the next sinus node beat lands exactly on the T of the PVC. This cannot be conducted to the ventricles, either because the ventricular myocardium is still unexcitable or the PVC has conducted retrogradely into the AV node and this is therefore still refractory.
Amongst the computer's several statements was the interpretation of "Undetermined rhythm". To the computer's statement, the reviewing cardiologist added the freehand text of "Abnormally slow" but failed to provide a diagnosis.
The computer interpreted this ECG as: Sinus bradycardia 1st degree AV block ST abnormality, possible digitalis effect Abnormal ECG When compared with ECG of(expunged) PR interval has increased
This week, in addition to my own blog, I'm going to feature a guest case study by Guru member Vince DiGiulio, EMT-CC. This past Monday, Vince messaged me (along with Dr. Ken Grauer) on Facebook and requested my input and opinion on these serial ECGs. With Vince's blessing, he gave me permission to use any of his original 12-lead ECGs here on the Guru. Of his 6 ECGs, I've decided to post 4 of them here.
