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Discussion

Pwave from .16 to .42?

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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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.

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

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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