ECG Guru - Instructor Resources - Junctional https://www.ecgguru.com/ecg/junctional en ECG Basics: Junctional Rhythm https://www.ecgguru.com/ecg/ecg-basics-junctional-rhythm-1 <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-1"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/150%20Junctional%20Rhythm%20strp.jpg" width="1800" height="190" 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>This is an example of a junctional rhythm that is slower than what is considered "intrinsic rate" for the junction. &nbsp;The rate is around 30 bpm. &nbsp;We know this is a "supraventricular" rhythm because of the narrow QRS. &nbsp;Junctional beats travel to the ventricles via the bundle branches, which provides very fast conduction, resulting in a narrow QRS complex. &nbsp;The P waves can be seen at the end of each QRS. &nbsp;They are upside-down in this Lead II rhythm strip, indicating <strong>retrograde</strong> conduction from the junctional pacemaker to the atria.</p><p>Clinically, the important thing when we encounter such a slow rate is to evaluate the patient's response to the rate. &nbsp;If the patient is hypoperfused (pale, decreased level of consciousness, low BP), we need to act to increase the rate, regardless of the cause of the bradycardia.</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/215/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 ECG Basics: Junctional Rhythm 1/5</option><option value="40">Give ECG Basics: Junctional Rhythm 2/5</option><option value="60" selected="selected">Give ECG Basics: Junctional Rhythm 3/5</option><option value="80">Give ECG Basics: Junctional Rhythm 4/5</option><option value="100">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 >3</span></span> <span class="total-votes">(<span >4</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-3Asvm4ShddrUVkV3Ydi2NwBypSKRypNByyRU8NyhPxA" /> <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" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Junctional</a></div><div class="field-item odd"><a href="/ecg/retrograde-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Retrograde conduction</a></div><div class="field-item even"><a href="/ecg/bradycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Bradycardia</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_1"> <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-1&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> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Thu, 19 Mar 2015 18:40:37 +0000 Dawn 628 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-junctional-rhythm-1#comments Pediatric ECG With Junctional Rhythm https://www.ecgguru.com/ecg/pediatric-ecg-junctional-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/pediatric-ecg-junctional-rhythm"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/MR118%20Peds.jpg" width="1800" height="1404" 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>This ECG, taken from a nine-year-old girl, shows a regular rhythm with a narrow QRS and an unusual P wave axis. Unfortunately, we do not have any clinical information.&nbsp;</p><p>Normally, P waves are positive in Leads I, II, and aVF and negative in aVR. &nbsp;They can be biphasic in V1, but are usually positive in the rest of the precordial leads. . The P waves in this ECG are NEGATIVE in Leads I,II, III, aVF, and V3 through V6. &nbsp;This indicates RETROGRADE conduction through the atria - the impulse starts low and continues in a backward fashion through the atria. This tells us that the rhythm originated in the AV junction or low atria. &nbsp;The "junction" is usually defined as all of the complex AV node and the Bundle of His.&nbsp;</p><p>The literature over the years has been very confusing about the exact location of the "junctional" pacemakers. &nbsp;One commonly-accepted guideline was that a rhythm is "junctional" if there are retrograde P waves with a short PR interval, or a P wave that occurs within or after the QRS.&nbsp; A rhythm with a retrograde P wave and a NORMAL PR interval is said to be "low atrial", indicating that the ectopic pacemaker involved was located in the low atrium, producing retrograde conduction through the atria and normal delay through the AV node.</p><p><span style="line-height: 1.538em;">While both of these scenarios are plausible, it probably is not possible to say with certainty where the actual pacemaker is just by looking at the surface ECG. &nbsp;The AV node has been found to have pacemaking capability in all three of it's regions, and the Bundle of His is also able to produce ectopic impulses. &nbsp;PR intervals vary greatly, especially in pediatric patients, and can be influenced by heart size and heart rate. &nbsp;The retrograde conduction through the AV node toward the atria can occur over the fast or slow pathways. The "major" junctional pacemaker is thought to be in the proximal Bundle of His. &nbsp;Junctional or low atrial ectopic rhythms can occur because they override the rate of the sinus rhythm, following the rule that "The fastest pacemaker controls the heart". &nbsp;junctional rhythms can also occur as "escape" rhythms, only occurring because the sinus impulse has failed or been vlocked - often due to AV block.</span></p><p>Since the exact location of the ectopic pacemaker in this case cannot be determined without electrophysiology studies, it is important to evaluate the effect, if any, the rhythm is having on the patient. Since there is a P wave before every QRS, and the QRS complexes are narrow, it can be assumed that there will be no clinical effect on this patient. &nbsp;In addition, the rate is within normal range, and that is also unlikely to produce any clinical effect.</p><p>The causes of ectopic rhythms are many, and range from completely benign to serious. &nbsp;So, this child should be evaluated in light of her symptoms, history, and physical assessment.</p><p>The ECG remains a good teaching example of retrograde P waves that are NOT dissociated from the QRS complexes.</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/215/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 Pediatric ECG With Junctional Rhythm 1/5</option><option value="40">Give Pediatric ECG With Junctional Rhythm 2/5</option><option value="60">Give Pediatric ECG With Junctional Rhythm 3/5</option><option value="80">Give Pediatric ECG With Junctional Rhythm 4/5</option><option value="100" selected="selected">Give Pediatric ECG With Junctional Rhythm 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.1</span></span> <span class="total-votes">(<span >8</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-5u2Kn86BootU0X-dncecB9_NdGGwXlZSdEhzHYce6NA" /> <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/pediatric-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pediatric ECG</a></div><div class="field-item odd"><a href="/ecg/junctional" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Junctional</a></div><div class="field-item even"><a href="/ecg/retrograde-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Retrograde conduction</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 class="field-item even"><a href="/ecg/inverted-p-waves" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Inverted P waves</a></div><div class="field-item odd"><a href="/ecg/av-nodal-rhythm" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">AV nodal 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_2"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fpediatric-ecg-junctional-rhythm&amp;title=%20Pediatric%20ECG%20With%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> Tue, 07 Oct 2014 06:07:52 +0000 Dawn 601 at https://www.ecgguru.com https://www.ecgguru.com/ecg/pediatric-ecg-junctional-rhythm#comments ECG Basics: Junctional Rhythm https://www.ecgguru.com/ecg/ecg-basics-junctional-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/ecg-basics-junctional-rhythm"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/118%20Junct%20rhythm.jpg" width="1800" height="337" 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>This rhythm strip illustrates a junctional escape rhythm. &nbsp;The sinus rhythm has slowed or stopped, and the junctional tissue has taken over as the pacemaker of the heart. &nbsp;The "junction" is loosely defined as the area between the AV node and the Bundle of His. &nbsp;The intrinsic rate of the pacemaking tissue in this area is 40 - 60 beats per minute. &nbsp;This slow rate is usually overridden by the sinus node, and the junction is not allowed to express itself as a pacemaker. &nbsp;Should the sinus node fail or fall below the junctional rate, the junction "escapes" and takes control of the heart. &nbsp;The QRS complex in junctional rhythm will normally be <strong>narrow</strong>, because the impulse follows the bundle branches down through the ventricles in a normal fashion, resulting in quick and normal ventricular depolarization.&nbsp;<span style="line-height: 1.538em;">&nbsp;If the QRS complex is wide in a junctional rhythm, there is another, separate cause, such as bundle branch block.</span></p><p><span style="line-height: 1.538em;">&nbsp;If the junctional impulse is able to penetrate the AV node and depolarlize the atria, the P wave will be deflected downward in Leads II, III, and aVF, as the impulse is travelling in a retrograde direction (backward). &nbsp;The P wave could end up slightly before the QRS, during the QRS, or after the QRS. In this strip, the P waves are seen after the QRS complexes.</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/215/feed" method="post" id="fivestar-custom-widget--3" 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--6" 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" selected="selected">Give ECG Basics: Junctional Rhythm 4/5</option><option value="100">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 >4</span></span> <span class="total-votes">(<span >4</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--3" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-2kVacXURMbEIt5vA8SxKQRz3LEaof8j5Mr0CMxrFCB0" /> <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/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/bradycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Bradycardia</a></div><div class="field-item even"><a href="/ecg/ecg-basics" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ECG Basics</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/junctional" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Junctional</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_3"> <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&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> Mon, 21 Oct 2013 04:29:48 +0000 Dawn 505 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-junctional-rhythm#comments