Here’s the conclusion to the January 2011 EMS 12-Lead column “Not So Fast…” at EMS1.com.
Congratulations to Vince DiGiulio for submitting the winning diagnosis!
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kevin
80 Year Old Female: “Rapid Heart Rate”
RBBB - I.V., serial 12-leads, oxygen-etco2, position semi-fowlers, bilateral BP, patch EP for consultation if transport is 30 minutes.
2019-02-25 01:16:26
80 Year Old Female: “Rapid Heart Rate”
RBBB - I.V., serial 12-leads, oxygen-etco2, position semi-fowlers, bilateral BP, patch EP for consultation if transport is 30 minutes.
2019-02-25 01:16:26
Goran
80 Year Old Female: “Rapid Heart Rate”
No sinus rythm,but rather atrial flutter with Mobitz type 1 - Wenkebach phenomen
2019-02-20 15:29:04
80 Year Old Female: “Rapid Heart Rate”
No sinus rythm,but rather atrial flutter with Mobitz type 1 - Wenkebach phenomen
2019-02-20 15:29:04
Goran
80 Year Old Female: “Rapid Heart Rate”
It is regularly irregular rythm.It seems like Mobitz type 1 - Wenkebach ,secondary to sinus tachycardia.It is visible P wave in V1 lead.We should find primary cause of sinus tachycardia?
2019-02-20 15:17:14
80 Year Old Female: “Rapid Heart Rate”
It is regularly irregular rythm.It seems like Mobitz type 1 - Wenkebach ,secondary to sinus tachycardia.It is visible P wave in V1 lead.We should find primary cause of sinus tachycardia?
2019-02-20 15:17:14
Paul
80 Year Old Female: “Rapid Heart Rate”
On first glance it looks like afib rvr new onset. Without marching the qrs complexes out though, it looks like they are pretty regular, like an accelerated junctional rhythm with every 4th beat dropped. Looks like a p wave can be seen in v1/2, but not sure and I would print a longer strip out…
2019-01-22 13:42:57
80 Year Old Female: “Rapid Heart Rate”
On first glance it looks like afib rvr new onset. Without marching the qrs complexes out though, it looks like they are pretty regular, like an accelerated junctional rhythm with every 4th beat dropped. Looks like a p wave can be seen in v1/2, but not sure and I would print a longer strip out…
2019-01-22 13:42:57
Ken Grauer
58 Year Old Male, Workout Worry
@ Eli — I don’t see AFlutter. That is, I see no indication of regular atrial activity at a rate consistent with AFlutter. Instead, the rhythm is irregularly irregular without P waves = AFib at a controlled ventricular response. In my opinion, one doesn’t need Sgarbossa criteria here to activate the cath lab. So, yes the…
2018-09-13 02:09:24
58 Year Old Male, Workout Worry
@ Eli — I don’t see AFlutter. That is, I see no indication of regular atrial activity at a rate consistent with AFlutter. Instead, the rhythm is irregularly irregular without P waves = AFib at a controlled ventricular response. In my opinion, one doesn’t need Sgarbossa criteria here to activate the cath lab. So, yes the…
2018-09-13 02:09:24
2 Comments
Strong work VinceD! I didn’t follow through on my PAC comment, and missed the obvious VT analogue “fusion complex”. Down at the bottom of the rhythm strip you can see the axis change fairly clearly.
Thanks! I didn’t even notice the upright complex in III through all the baseline movement either, I just blew off those areas of II and III as useless at the time and moved on. I was pushing things a bit by calling it a fusion beat based off the narrower R-wave without that much more conclusive evidence, nice find.