ECG Guru - Instructor Resources - Vagotonic A-V block https://www.ecgguru.com/ecg/vagotonic-v-block en Jason's Blog: ECG Challenge of the Week for July 22-29. What are the causes of these patterns? https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-july-22-29-what-are-causes-these-patterns <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/jasons-blog-ecg-challenge-week-july-22-29-what-are-causes-these-patterns"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201e-1a%20answer.png" width="765" height="509" alt="" /></a></div><div class="field-item odd"><a href="/blog/jasons-blog-ecg-challenge-week-july-22-29-what-are-causes-these-patterns"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201e-2a%20answer.png" width="765" height="644" alt="" /></a></div><div class="field-item even"><a href="/blog/jasons-blog-ecg-challenge-week-july-22-29-what-are-causes-these-patterns"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201e-2b%20answer.png" width="765" height="631" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>&nbsp;</p> <p><span style="font-size: small;">I recently performed both of these ECGs a few days apart during the same work week.&nbsp; They were recorded on an outpatient basis.&nbsp; It wasn’t until I recorded the second ECG that I realized I had a good pair of ECGs to illustrate this comparison.</span><br><br><span style="font-size: small;">At a superficial glance, both of these appear to represent the same thing and some people&nbsp;might even argue that both of these ECGs have identical interpretations but they would be wrong.&nbsp; One of these represents a conventional example that is <em>intrinsic</em> to the heart and it's conduction system.&nbsp; The other is a lesser-known example and is <em>extrinsic</em> to the heart.&nbsp; Admittedly, they do share similar characteristics however there are several contrasting features as well.<span class="MsoNormal">&nbsp;</span> </span><br><br><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;"><span style="color: blue;">Fig. # 1</span></span></strong> </span><br><br><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;"><span style="color: #c00000;">Patient's clinical data:</span></span></strong> &nbsp;68-year-old white man.&nbsp; </span><span style="font-size: small;">History of hypertension.</span><br class="MsoNormal"><br><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;"><span style="color: blue;">Fig. # 2</span></span></strong></span><br><br><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;"><span style="color: #c00000;">Patient's clinical data:</span></span></strong>&nbsp; 57-year-old black man. </span><br><br><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;">The computer interpreted <span style="color: blue;">Fig. # 2</span> as:</span></strong></span></p> <table class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-yfti-tbllook: 1184; mso-padding-alt: 0in 5.4pt 0in 5.4pt;" border="1" cellspacing="0" cellpadding="0"> <tbody> <tr style="mso-yfti-irow: 0; mso-yfti-firstrow: yes; mso-yfti-lastrow: yes;"> <td style="width: 6.65in; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top" width="638"> <p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: small;">Marked sinus bradycardia with marked sinus arrhythmia 1st degree AV block</span><br><span style="font-size: small;">Voltage criteria for left ventricular hypertrophy</span><br><span style="font-size: small;">Abnormal ECG</span><br><span style="font-size: small;">When compared with ECG of <em style="mso-bidi-font-style: normal;">(deleted)</em></span><br><span style="font-size: small;">PR interval has increased</span></p> </td> </tr> </tbody> </table> <p class="MsoNormal"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;">DO YOU AGREE WITH THE COMPUTER?</strong></span><br><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;"><span style="line-height: 115%; color: #009900;"><br>QUESTIONS:</span></span></strong>&nbsp; </span></p> <p><span style="font-size: small;"><span style="line-height: 115%;">What are the causes of the pauses and the "group beating"?&nbsp; Do either of these patients need a pacemaker?</span>&nbsp;<span style="line-height: 115%;"> <br><br><span style="text-decoration: underline;"><strong>Hint:</strong></span>&nbsp; In <span style="color: blue;">Fig. # 2</span>, pay careful attention to the sinus P-P intervals and their correlation with the timing of the pauses.&nbsp; Compare the <em style="mso-bidi-font-style: normal;">PR intervals</em> and their corresponding <em>RP intervals</em>.&nbsp; Also contrast the lengths of the longest and shortest RR intervals. &nbsp;This will help to differentiate it from <span style="color: blue;">Fig. # 1</span>.</span></span></p> </div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/151/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for July 22-29. 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