ECG Guru - Instructor Resources - Idiojunctional rhythm https://www.ecgguru.com/ecg/idiojunctional-rhythm 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><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/422/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 Junctional or Low Atrial Rhythm 1/5</option><option value="40">Give Junctional or Low Atrial Rhythm 2/5</option><option value="60">Give Junctional or Low Atrial Rhythm 3/5</option><option value="80" selected="selected">Give Junctional or Low Atrial Rhythm 4/5</option><option value="100">Give Junctional or Low Atrial Rhythm 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.8</span></span> <span class="total-votes">(<span >5</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-OZlmpPdU25oaUkkBhVak6TFbGDoSgKvEaicyRvpBrN0" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/junctional-rhythm" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Junctional rhythm</a></div><div class="field-item odd"><a href="/ecg/idiojunctional-rhythm" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Idiojunctional rhythm</a></div><div class="field-item even"><a href="/ecg/junctional-escape-rhythm" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Junctional escape rhythm</a></div><div class="field-item odd"><a href="/ecg/low-atrial-rhythm" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Low atrial rhythm</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fjunctional-or-low-atrial-rhythm&amp;title=Junctional%20or%20Low%20Atrial%20Rhythm"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Sun, 10 Jun 2018 19:33:02 +0000 Dawn 757 at https://www.ecgguru.com https://www.ecgguru.com/ecg/junctional-or-low-atrial-rhythm#comments 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><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/422/feed" method="post" id="fivestar-custom-widget--2" 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--4" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give ECG Basics: Junctional Rhythm 1/5</option><option value="40">Give ECG Basics: Junctional Rhythm 2/5</option><option value="60">Give ECG Basics: Junctional Rhythm 3/5</option><option value="80">Give ECG Basics: Junctional Rhythm 4/5</option><option value="100" selected="selected">Give ECG Basics: Junctional Rhythm 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >5</span></span> <span class="total-votes">(<span >2</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--2" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-uIUlQdqtVAAtmuEtpSccNIhgZIfrlh8n_qFVkIT_Obo" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/idiojunctional-rhythm" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Idiojunctional rhythm</a></div><div class="field-item odd"><a href="/ecg/junctional-rhythm" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Junctional rhythm</a></div><div class="field-item even"><a href="/ecg/retrograde-p-waves" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Retrograde P waves</a></div><div class="field-item odd"><a href="/ecg/basic-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Basic ECG</a></div><div class="field-item even"><a href="/ecg/rhythm-strip" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Rhythm strip</a></div><div class="field-item odd"><a href="/ecg/ecg-basics" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ECG Basics</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_2"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fecg-basics-junctional-rhythm-0&amp;title=ECG%20Basics%3A%20%20Junctional%20Rhythm"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 29 Dec 2013 00:59:39 +0000 Dawn 535 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-junctional-rhythm-0#comments