ECG Guru - Instructor Resources - Escape rhythm https://www.ecgguru.com/ecg/escape-rhythm en Inferior-posterior Wall M.I. and AV Dissociation https://www.ecgguru.com/ecg/inferior-posterior-wall-mi-and-av-dissociation <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/inferior-posterior-wall-mi-and-av-dissociation"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/IWMI%200019.jpg" width="1800" height="1104" alt="" /></a></div><div class="field-item odd"><a href="/ecg/inferior-posterior-wall-mi-and-av-dissociation"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/IWMI%200019%20for%20Guru%20RS.jpg" width="1800" height="191" 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">At the ECG Guru website, our main goal is to provide quality teaching materials to those who teach ECG interpretation and other cardiac topics.<span style="mso-spacerun: yes;">&nbsp; </span>This ECG offers teaching opportunities for those who teach any level of student.</p><p class="MsoNormal"><strong><span style="color: #00b050;">The patient:</span></strong><span style="color: #00b050;"><span style="mso-spacerun: yes;">&nbsp;&nbsp; </span></span>This ECG was obtained in the Emergency Department from a 54-year-old man who was complaining of severe chest pain and nausea.<span style="mso-spacerun: yes;">&nbsp; </span>His BP was 130/68.</p><p class="MsoNormal"><strong><span style="color: #00b050;">The ECG:</span></strong><span style="color: #00b050;"><span style="mso-spacerun: yes;">&nbsp; </span></span>The rhythm is interesting and not uncommon in the setting of inferior wall M.I.<span style="mso-spacerun: yes;">&nbsp; </span>The atrial rate is about 158 bpm and the P waves are regular. (Marked in red on accompanying rhythm strip).&nbsp; &nbsp;Some P waves are hidden in T waves or ST segments, but we can see fragments of them. The QRS complexes are narrow and mostly regular at a rate of about 56 bpm.<span style="mso-spacerun: yes;">&nbsp; </span>The second QRS on the strip is early, but from the third QRS on, they are regular. The PR intervals are not consistent.<span style="mso-spacerun: yes;">&nbsp; </span>Careful measurements will show that they get shorter and shorter as the recording progresses.<span style="mso-spacerun: yes;">&nbsp; </span>There are more P waves than QRS complexes and there is NO association between the P waves and the QRS complexes, so there is <strong>AV DISSOCIATION</strong>.<span style="mso-spacerun: yes;">&nbsp; </span>One might argue that the first two QRS complexes are conducted from the P waves, with a shorter PR interval with beat #1 and a longer one with beat #2. This would be a short episode of Wenckebach conduction if that is what is happening.<span style="mso-spacerun: yes;">&nbsp; </span>Since we don’t have a strip preceding this one, we can’t be sure.<span style="mso-spacerun: yes;">&nbsp; </span>Clinically, it is smart to address where the patient is now, and that is <strong>SINUS TACHYCARDIA WITH AV DISSOCIATION AND A JUNCTIONAL</strong> <strong>RHYTHM.</strong> Or, it would be fine, after the first two beats, to say the patient is now in COMPLETE AV BLOCK WITH JUNCTIONAL ESCAPE or THIRD-DEGREE AV BLOCK WITH JUNCTIONAL ESCAPE.<span style="mso-spacerun: yes;">&nbsp; </span>We know that this conduction failure is occurring at the level of the AV node because the escape rhythm is junctional.<span style="mso-spacerun: yes;">&nbsp; </span>Blocks at the AV node level are often temporary. <span style="mso-spacerun: yes;">&nbsp;</span>A block lower than this, from the His Bundle through the common branch of the bundle branches, would produce a ventricular escape rhythm.<span style="mso-spacerun: yes;">&nbsp; </span>The important thing, if you are the patient’s health care provider, is that you assess this rate for adequate perfusion.<span style="mso-spacerun: yes;">&nbsp; </span>A heart rate of 57 is almost always sufficient for good perfusion, and is actually preferable for a patient with an ongoing M.I.<span style="mso-spacerun: yes;">&nbsp; </span>Which would you rather have if you were having an M.I., a heart rate of 57 or 158 bpm?<span style="mso-spacerun: yes;">&nbsp; </span><strong><em>Could we say that this AV block has actually HELPED this particular patient?</em></strong><span style="mso-spacerun: yes;">&nbsp; </span>I will happily leave more advanced discussions of this arrhythmia to our commenters.</p><p class="MsoNormal">The <strong>ST segments are noticeably elevated</strong> in Leads II, III, and aVF.<span style="mso-spacerun: yes;">&nbsp; </span>There is <strong>reciprocal ST depression</strong> in Leads I and aVL, and also in the anterior leads. Lead III has a deep, but not wide <strong>Q wave.</strong> This pushes the frontal axis a bit to the left (I and aVL are taller than II). <span style="mso-spacerun: yes;">&nbsp;</span>The T waves in many leads are “hyperacute”.<span style="mso-spacerun: yes;">&nbsp; </span>That is, they are taller than expected, which is a sign of ischemia.<span style="mso-spacerun: yes;">&nbsp; </span>This patient was confirmed to have a <strong>INFERIOR WALL M.I. </strong><span style="mso-spacerun: yes;">&nbsp;</span>Since the RCA supplies the inferior wall and the AV node in the majority of people, it is not surprising that there is an AV block at the level of the AV node. Also, the posterior wall is supplied by the RCA in most people, and the ST depression in the anterior wall with prominent R waves in the septal leads point to posterior M.I.&nbsp; The much less prominent ST depression in V1, as compared to V2, indicates that the right ventricle is sending a signal to V1 to "elevate", while the posterior wall tells V1 to "depress". This results in an ST segment that is cancelled by opposing forces.&nbsp; This would be a good patient to perform V4Right, V7, V8, and V9 on (16-lead ECG).</p><p class="MsoNormal">This is a good ECG to demonstrate what ST segment elevation looks like in acute M.I., as opposed to other causes of STE.<span style="mso-spacerun: yes;">&nbsp; </span>In M.I., we see certain characteristics:</p><p class="MsoListParagraphCxSpFirst" style="text-indent: -.25in; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="mso-spacerun: yes;">&nbsp;</span>The STE is found localized in related leads</p><p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="mso-spacerun: yes;">&nbsp;</span>The ST segments tend to be straight or curved upward, rather than the normal convex shape</p><p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="mso-spacerun: yes;">&nbsp;</span>There is ST depression is leads that are opposite the elevation (See III and aVL)</p><p class="MsoListParagraphCxSpLast" style="text-indent: -.25in; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><span style="mso-spacerun: yes;">&nbsp;</span>There are accompanying signs of M.I., such as T wave inversion, hyperacute T waves, and pathological Q waves. <span style="mso-spacerun: yes;">&nbsp;</span></p><p class="MsoNormal">This ECG can also serve to start a conversation with students about when it is appropriate to treat bradycardia, and when it is best left alone.</p><p class="MsoNormal">EDIT: Dr. Ken Grauer has written a very informative and thought-provoking comment below. If you would like to hear his thoughts on this ECG in more depth, go to his blog at&nbsp;<a href="https://ecg-interpretation.blogspot.com/2021/12/ecg-blog-268-76-mobitz-i-vs-complete-av.html?m=1">https://ecg-interpretation.blogspot.com/2021/12/ecg-blog-268-76-mobitz-i-vs-complete-av.html?m=1</a></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/272/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 Inferior-posterior Wall M.I. and AV Dissociation 1/5</option><option value="40">Give Inferior-posterior Wall M.I. and AV Dissociation 2/5</option><option value="60">Give Inferior-posterior Wall M.I. and AV Dissociation 3/5</option><option value="80" selected="selected">Give Inferior-posterior Wall M.I. and AV Dissociation 4/5</option><option value="100">Give Inferior-posterior Wall M.I. and AV Dissociation 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.1</span></span> <span class="total-votes">(<span >56</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-miQWl0uurc9DOwgfJXZdzpY9xlkoU980N3uwiKcb0CM" /> <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/inferior-mi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Inferior M.I.</a></div><div class="field-item odd"><a href="/ecg/stemi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">STEMI</a></div><div class="field-item even"><a href="/ecg/st-elevation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ST elevation</a></div><div class="field-item odd"><a href="/ecg/reciprocal-st-changes" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Reciprocal ST changes</a></div><div class="field-item even"><a href="/ecg/av-dissociation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">AV dissociation</a></div><div class="field-item odd"><a href="/ecg/right-ventricular-mi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Right ventricular M.I.</a></div><div class="field-item even"><a href="/ecg/posterior-mi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Posterior M.I.</a></div><div class="field-item odd"><a href="/ecg/third-degree-av-block-1" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Third-degree AV block</a></div><div class="field-item even"><a href="/ecg/complete-av-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Complete AV block</a></div><div class="field-item odd"><a href="/ecg/escape-rhythm" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Escape rhythm</a></div><div class="field-item even"><a href="/ecg/junctional-escape" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Junctional escape</a></div><div class="field-item odd"><a href="/ecg/right-coronary-artery-occlusion" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Right coronary artery occlusion</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%2Finferior-posterior-wall-mi-and-av-dissociation&amp;title=Inferior-posterior%20Wall%20M.I.%20and%20AV%20Dissociation"><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> Mon, 06 Dec 2021 23:59:10 +0000 Dawn 810 at https://www.ecgguru.com https://www.ecgguru.com/ecg/inferior-posterior-wall-mi-and-av-dissociation#comments High-grade AV Block https://www.ecgguru.com/ecg/high-grade-av-block-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/high-grade-av-block-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AVB113.jpg" width="1800" height="656" alt="" /></a></div><div class="field-item odd"><a href="/ecg/high-grade-av-block-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AVB113%2010%2037.jpg" width="1800" height="695" 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>To continue on a topic started by Jason Roediger in his <a href="http://ecgguru.com/blog/jasons-blog-ecg-challenge-month-february-2014">February ECG Challenge</a> -</p><p>This series of two ECGs was taken from a 71-year-old man who complained of dizziness and near-syncope the day before these ECGs were done. &nbsp;He was seen in an Emergency Dept., and advised to follow up with a neurologist. On the day of these ECGs, still feeling dizzy and like he would pass out, he called EMS again. &nbsp;He denied chest pain. &nbsp;We do not know his past medical history. &nbsp;The first ECG was taken at 10:22 am. &nbsp;His BP was 177/76 and SpO2 99%. &nbsp;It shows a regular sinus rhythm (p waves marked by small asterisks) at a rate of about 75 / min. &nbsp;There is a high-grade AV block, meaning that some P waves are conducted (beats 2, 4, 7), but most are not. &nbsp;In addition, he has an escape rhythm, probably ventricular, at a rate of just over 40 / min. &nbsp;The overall effect of the escape rhythm is to keep the heart rate above 40 beats per minute.</p><p>Fifteen minutes later, at 10:37 am, another ECG is taken. &nbsp;The patient's BP is 154/86. &nbsp; This ECG shows the high-grade AV block quite well, but this time, most of the QRS complexes on the strip are conducted from P waves. &nbsp;It is difficult to see all the P waves in every lead, but if you remember that all three channels are run simultaneously, you will find evidence of the P waves in at least one of the three leads represented at any given time. &nbsp;(Example: &nbsp;V1, V2, and V3 - V3 shows the P waves well). &nbsp;The next-to-last QRS on the page is interesting, as it has a different PRI than the normally conducting beats. &nbsp;Is this a fusion beat or an aberrantly-conducted one? &nbsp; It probably does not matter to the outcome of the patient.&nbsp;</p><p>The <strong>slowing of the rate</strong> in the second strip gives us a clue as to why the patient felt dizzy, but the blood pressures recorded did not catch hypotension. &nbsp;Possibly if the patient had been standing instead of lying on a stretcher, we would have seen more hemodynamic changes.</p><p>Unfortunately, we do not know the outcome of this patient, but it seems he is a candidate for an implanted pacemaker.</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/272/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 High-grade AV Block 1/5</option><option value="40">Give High-grade AV Block 2/5</option><option value="60">Give High-grade AV Block 3/5</option><option value="80">Give High-grade AV Block 4/5</option><option value="100" selected="selected">Give High-grade AV Block 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.3</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--2" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-3SxYyzi6EWXbFYVob_qWSr4ZyLHOgLYCO66qgWSvr8g" /> <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/av-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">AV Block</a></div><div class="field-item odd"><a href="/ecg/high-grade-av-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">High-grade AV Block</a></div><div class="field-item even"><a href="/ecg/escape-rhythm" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Escape rhythm</a></div><div class="field-item odd"><a href="/ecg/second-degree-av-block-type-ii" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Second-degree AV block Type II</a></div><div class="field-item even"><a href="/ecg/idioventricular-escape-rhythm" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Idioventricular escape 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%2Fhigh-grade-av-block-0&amp;title=High-grade%20AV%20Block"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Thu, 13 Mar 2014 20:42:48 +0000 Dawn 561 at https://www.ecgguru.com https://www.ecgguru.com/ecg/high-grade-av-block-0#comments Third-degree AV Block and Junctional Escape Rhythm With Right Bundle Branch Block and Prolonged QTc Interval https://www.ecgguru.com/ecg/third-degree-av-block-and-junctional-escape-rhythm-right-bundle-branch-block-and-prolonged-qtc <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/third-degree-av-block-and-junctional-escape-rhythm-right-bundle-branch-block-and-prolonged-qtc"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AVB111_1.jpg" width="1699" height="1247" 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 is from a 70 year old woman for which we have, unfortunately, no clinical information.&nbsp; It shows a sinus rhythm with a rate of about 72 bpm (NSR) with AV dissociation caused by third-degree heart block.&nbsp; The escape rhythm is junctional at a rate of 38 bpm.&nbsp; There appears to be a right bundle branch block, based on the QRS duration of 132 ms, and a wide S wave in Leads I and V6.&nbsp; The precordial leads do not show the usual RBBB pattern of rSR' in V1 and V2, and the r wave progression is poor (non-existent).&nbsp; This is felt to be due to poor lead placement (a good teaching point).&nbsp; Of interest, the ECG machine has reported a "severe right axis deviation" based on the tall upright R wave in aVR and the deep S in avF.&nbsp; In RBBB, the first part of the QRS represents left ventricular depolarization, and the terminal wave represents the delayed right ventricle.&nbsp; In effect, the two ventricles have their own electrical axes, which we can see because the ventricles are not depolarizing simultaneously.&nbsp; The axis of the LV appears to be normal in this tracing.</p><p>In addition to the above, this patient has a very prolonged QT interval.&nbsp; The QT is longer in bradycardic rhythms, but when corrected to a standard of 60 bpm (QTc), this patient's QT interval is still prolonged at QTc: 552 ms.&nbsp; Without clinical data, we cannot speculate&nbsp; as to why this patient's QTc is prolonged, but it can be a very dangerous situation.&nbsp; Follow the links for more information on <a title="QT Prolongation and Torsades" href="http://www.medsafe.govt.nz/profs/PUArticles/DrugInducedQTProlongation.htm">QT prolongation</a> and Torsades de Pointes and <a title="Long QT Syndrome" href="http://emedicine.medscape.com/article/157826-overview">Long QT Syndrome</a>.</p><p>As always, we welcome comments from&nbsp;our members adding insight to this interesting ECG, and also questions you would like to ask our Guru members.</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/272/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 Third-degree AV Block and Junctional Escape Rhythm With Right Bundle Branch Block and Prolonged QTc Interval 1/5</option><option value="40">Give Third-degree AV Block and Junctional Escape Rhythm With Right Bundle Branch Block and Prolonged QTc Interval 2/5</option><option value="60">Give Third-degree AV Block and Junctional Escape Rhythm With Right Bundle Branch Block and Prolonged QTc Interval 3/5</option><option value="80" selected="selected">Give Third-degree AV Block and Junctional Escape Rhythm With Right Bundle Branch Block and Prolonged QTc Interval 4/5</option><option value="100">Give Third-degree AV Block and Junctional Escape Rhythm With Right Bundle Branch Block and Prolonged QTc Interval 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 >5</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-F9E9MsfmAvQoJ6M7VIEqKx2SzvuyjVHaaS67i-BXQSY" /> <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/av-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">AV Block</a></div><div class="field-item odd"><a href="/ecg/third-degree-av-block-1" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Third-degree AV block</a></div><div class="field-item even"><a href="/ecg/escape-rhythm" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Escape rhythm</a></div><div class="field-item odd"><a href="/ecg/right-bundle-branch-block-1" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Right bundle branch block</a></div><div class="field-item even"><a href="/ecg/rbbb" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">RBBB</a></div><div class="field-item odd"><a href="/ecg/bundle-branch-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Bundle branch block</a></div><div class="field-item even"><a href="/ecg/prolonged-qtc-interval" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Prolonged QTc interval</a></div><div class="field-item odd"><a href="/ecg/long-qt-syndrome" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Long QT Syndrome</a></div><div class="field-item even"><a href="/ecg/torsades-de-pointes" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Torsades de Pointes</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></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%2Fthird-degree-av-block-and-junctional-escape-rhythm-right-bundle-branch-block-and-prolonged-qtc&amp;title=Third-degree%20AV%20Block%20and%20Junctional%20Escape%20Rhythm%20With%20Right%20Bundle%20Branch%20Block%20and%20Prolonged%20QTc%20Interval%20"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sat, 26 Jan 2013 19:48:30 +0000 Dawn 396 at https://www.ecgguru.com https://www.ecgguru.com/ecg/third-degree-av-block-and-junctional-escape-rhythm-right-bundle-branch-block-and-prolonged-qtc#comments