Rhythm Nation August 2014

70 yo M with pmh DM and HTN presents with chest pain and a troponin of 41. STEMI code activated and patient taken to cath lab. Here is his EKG upon arrival:

photo (1)

1. What is this rhythm?

2. What is the treatment for this rhythm?

Answers were due 8/15/2014… now you can click here for the answer!

 

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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eabram

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3 comments for “Rhythm Nation August 2014

  1. dzeccola
    August 13, 2014 at 9:04 am

    1) Junctional Rhythm

    2) Treat the underlying ischemia. Also put pacer pads on the patient because this is a sign of poor cardiac automaticity and they may decompensate. That said don’t pace them now as long as their Junctional rhythm is perfusing.

  2. jfreedman
    August 14, 2014 at 5:21 am

    junctional is reasonable without p waves….but why is it wide? when interpreting ecg’s, you’ve got to be comprehensive.

    rate : 100
    rhythm: regular, wide. no p waves. ventricular vs abberant junctional
    axis: Left
    intervals: wide QRS. no PR. normal QT
    ST segments: no excessive discordance
    q waves diffusely

    DDx: Wide, regular, fast but not too fast. No p waves. DDx junctional with abberancy vs ventricular etiology, vs electrolyte vs tox. This is likely ventricular in etiology as there is no typical LBBB or RBBB ( long and insensitive criteria exist for discriminating between supraventricular with abberancy and ventricular)

    In setting of recent MI, this is a reperfusion rhythm. This is benign and self-limited. treatment with electricity or anti-dysrhtmics can have disastrous consequences. Let it be.

    1. accelerated idioventricular rhythm (not fast enough to call V tach)

    2. Do nothing.

  3. jfreedman
    August 14, 2014 at 8:02 am

    misspoke. doesnt necessarily have to be aberrant junctional. could be aberrantly conducted anything without p waves…

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