What is the Rhythm?

-----------------------------------------------------------Presentation by KEN GRAUER, MD (1/31/2019):-----------------------------------------------------------The Case: A previously healthy 23-year old male presents to the ED for shortness of breath and chest pressure that occurred ~3 hours earlier. He was at a track meet cheering, when he suddenly felt his heart “skip a beat”, and then begin “racing”. He felt “lightheaded” (presyncopal) during the episode — with the “strong sensation of his heart beating”. He did not feel better until ~45 minutes later. Similar episodes had occurred over the past month — but none lasted as long, which is the reason he presented at this time. Of note, the patient is very active — and he runs several miles several times a week. Figure-1 shows his initial ECG that was obtained in the ED.P.S. The patient states that his mother “has a junctional rhythm”.Questions:What is the rhythm in Figure-1?Why is this not “isorhythmic” AV dissociation?Might the fact that this patient ’s mother is known “to have a junctional rhythm” have anything to do with this case?Clinically — What would you do for this patient?Hint:Use of calipers is strongly advised for interpreting the rhythm!Figure-1: The initial ECG in this case (See text). ==========================PEARL #1: The easiest way to instantly enhance your arrhythmia interpre...

Source: Dr. Smith's ECG Blog - January 31, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs