Pwave from .16 to .42?

Specialties Cardiac

Published

Specializes in cardiac.

Anyone ever see this before? We were kinda stooped at work yesterday on this one. Pt had normal sinus rhythm with a pwave interval of .16. Then, went to a pwave interval of .42. Mind you, we realized this was a first degree block. But, the pt kept going in and out of this rhythm a few times. Eventually, pt converted back to normal sinus rhythm with the pwave at .16. We asked cardiologist about it. Couldn't really figure out what he said. Was this just a fluke thing? This was only showing up in one lead. Checked all leads, they were good. The Pwave was not inverted. Otherwise I would have gone with something like a junctional rhythm. Anyone familiar with this? I'm just curious because I have never seen this type thing happen before.:smokin:

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Specializes in Critical Care.

It happens all the time. Could be a transient second degree (type I), could be medication-induced heart block, could be a wandering pacer.

As with any FLB (funky lookin' beats), it's best to clinically correlate your findings with the patient.

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Specializes in SICU/CVICU.

If it's just showing up in 1 lead it's probably nothing.

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Specializes in ICU, ER (ED), CCU, PCU, CVICU, CCL.

was it consistant at .42 for several beats? how long did it last?

Was it just a retrograde P (as you stated a junctional). Was it a WB? The SA has a recovery time (in EP called SNRT) in which the SA none in older hearts or deseased hearts can only recieve a signal so fast then it refuses to let out a P wave.... this is what is called a Weinke-Back. The SA node recovery acts as a gate for signal transmission and only "pulses" so fast until it "resets". What you might have seen was simply a Sinus arrest.

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