Sticking with the same general theme from my last ECG Challenge for the months of September and October, 2013. This is more of a back-to-basics for some readers but will still challenge others. No information for this patient other than it was an adult. How would you interpret this?
TODAY, we are starting a new feature on the ECG GURU. ECG BASICS will provide rhythm strips and 12-leads for your beginner or refresher students. It can be discouraging to the entry-level student to see only intermediate or advanced material and not understand it. We must remember to start at the most elementary concepts, and then build on them, just as we do with any other subject. Even more advanced students sometimes benefit from a return to the "basics". In this weekly feature, you will find downloadable content that is, like all ECG Guru content, FREE for use in an educational context. Please let us know in the "Comments" section below what ECGs, rhythm strips, or illustrations you would like to see featured in this new area.
Today's strip: Sinus bradycardia with first-degree AV block. The rate is in the 30's and slowing, and the PR interval is .26 seconds.
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.
This is a good ECG for demonstrating sinus brady and first-degree AV block. It shows the sinus node in the process of slowing down. For your more advanced students, there is left axis deviation due to left anterior fascicular block (left anterior hemiblock). The ST segments are flat, suggesting coronary artery disease. The fourth (bottom) channel is a good rhythm strip. Just crop the image. Please refer to Dr. Grauer's interesting post on teaching hemiblocks on our Ask The Expert page.
Patient's clinical data: This 12-lead ECG is from an adult patient of unknown age and gender (at the time of posting). Active medications included Atenolol. Patient's only complaints and symptoms were cramps and palpitations in the form of "an occasional extra beat". This ECG was the patient's initial "baseline". Based on what the patient's primary care provider (PCP) misinterpreted in this ECG, the patient ended up having an erroneous diagnosis listed among their "active problems". Their computerized
I performed this ECG earlier this year in an outpatient clinic.
Patient's clinical data: 85-year-old white man; asymptomatic.
Questions? (1.) What rhythm is this tracing showing? (2.) What clue/sign is used to differentiate between the two anomalous beats (i.e., 4th and 6th beats). HINT: It's named after a part of a certain animal's anatomy.
