Idiojunctional rhythm https://www.ecgguru.com/taxonomy/term/422/all en Junctional or Low Atrial Rhythm https://www.ecgguru.com/ecg/junctional-or-low-atrial-rhythm <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/junctional-or-low-atrial-rhythm"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Junctional%20Rhythm%20edit%20for%20Guru.jpg" width="1800" height="644" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal"><strong>The Patient &nbsp;&nbsp;</strong>This ECG was recorded from an 86-year-old man who was weak, pale, and diaphoretic. He was hypotensive, with a BP of 88/54.<span style="mso-spacerun: yes;">&nbsp; </span>He denied chest pain or shortness of breath.</p><p class="MsoNormal"><strong>The ECG &nbsp;&nbsp;</strong>The 12-lead ECG shows a bradycardia at about 60 beats per minute and regular.<span style="mso-spacerun: yes;">&nbsp; </span>The QRS complexes are narrow, at a little less than .08 seconds (800 ms).<span style="mso-spacerun: yes;">&nbsp; </span>The P waves are negative in Leads II, III, and aVF and positive in aVR.<span style="mso-spacerun: yes;">&nbsp; </span>This is an indication that the P waves are traveling in a “retrograde” fashion – backward. The origin of the P waves has to be the AV junction or the lower atria for this to happen.<span style="mso-spacerun: yes;">&nbsp; </span>The PR interval is on the short side of normal at about .12 seconds (120 ms), possibly even less.<span style="mso-spacerun: yes;">&nbsp; </span>This is common in junctional rhythm, as the impulse starts at the AV junction, and travels back through the atria and forward through the ventricles at the same time.</p><p class="MsoNormal">There are no premature beats, and the ST segments are not elevated or depressed. There are no T wave inversions, except for aVR, where it is normal.</p><p class="MsoNormal"><strong>Assessment &nbsp; &nbsp;</strong>One cause of junctional rhythm is sinus brady.<span style="mso-spacerun: yes;">&nbsp; </span>That is, the sinus node begins firing so slowly that the junctional pacemaker “escapes”, and takes control of the heart.<span style="mso-spacerun: yes;">&nbsp; </span>When the sinus node speeds up, it may once again take over the heart’s rhythm from the junction.<span style="mso-spacerun: yes;">&nbsp; </span><em style="mso-bidi-font-style: normal;">The fastest pacemaker controls the heart. </em>A junctional rhythm may escape when the sinus node fails or there is a complete AV block in the AV node area.</p><p class="MsoNormal"><strong>Patient Outcome &nbsp; &nbsp;</strong>This patient was diagnosed with orthostatic hypotension, bronchitis, and urinary tract infection. He was treated in the hospital and cleared by a cardiologist for discharge two days later.</p><p class="MsoNormal">Our thanks to Michael Francis and Chris Burden for donating this ECG.</p></div></div></div> Sun, 10 Jun 2018 19:33:02 +0000 Dawn 757 at https://www.ecgguru.com ECG Basics: Junctional Rhythm https://www.ecgguru.com/ecg/ecg-basics-junctional-rhythm-0 <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/ecg-basics-junctional-rhythm-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/125%20Junctional%20Rhythm.jpg" width="1810" height="367" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>A basic rhythm strip showing junctional rhythm in Lead II. &nbsp;The junctional pacemaker is located between the atria and the ventricles, and the resulting P wave is caused by retrograde conduction through the atria. &nbsp;This causes the P wave to be negatively deflected in Lead II. &nbsp;In junctional rhythms, the P wave can occur just before the QRS, during the QRS, or after the QRS, or may not be seen at all. &nbsp;If the P wave occurs before the QRS, the PR interval is usually short, reflecting the fact that the atria and the ventricles are depolarized almost simultaneously. &nbsp;In this example, the PRI is .12, on the short side of normal.</p><p>The junctional pacemakers have a slow intrinsic rate so that the sinus node can remain in control of the heart's rate under normal circumstances. &nbsp;If the sinus rate drops below the intrinsic rate of the junctional pacemaker, the junction will take over control of the heart. &nbsp;An idiojunctional rhythm is generally between 40 and 60 bpm. &nbsp;In this example, it is about 63 bpm.</p></div></div></div> Sun, 29 Dec 2013 00:59:39 +0000 Dawn 535 at https://www.ecgguru.com