AJJKRN 1,224 Posts Specializes in Medical-Surgical/Float Pool/Stepdown. Has 6+ years experience. Sep 7, 2015 Honestly is looks like sinus rythm with a notched p wave and a bundle branch block but it's been awhile since I studied/watched rhythms when I was a monitor tech about five years ago so I'm a bit rusty! Lead II from what I remember is the tell tell whether or not the p wave is positive or negative so that the lead I used to look at to rule out junctional. So what's the debate came up with so far?
Editorial Team / Admin dianah, ASN 9 Articles; 3,836 Posts Specializes in RETIRED Cath Lab/Cardiology/Radiology. Has 48 years experience. Sep 7, 2015 PR = normal = sinus rhythmQRS = 0.08 (could be 0.10, but am calling it 0.08) = normal.Need to see AVR, AVF, AVL.Are the 3 at the bottom leads I, II, III?
MendedHeart 663 Posts Sep 7, 2015 What's the rate?. I was wondering if this could be a hidden Atrial flutter? I have seen them look lile this a few times. Also, look at the p wave morphology.
Susie2310 2,114 Posts Sep 7, 2015 I am seeing sinus rhythm as the underlying rhythm. I am also seeing a possible early stage MI in lead V4, and am assuming that what appears to me as a left bundle branch block in lead VI is a new finding. In lead V3 I am seeing what looks to me like an early repolarization.
MendedHeart 663 Posts Sep 7, 2015 Could it be a F wave on a t wave making look like STE? Flutter does break the isoelectric line?
Mavrick, BSN, RN 1,578 Posts Specializes in 15 years in ICU, 22 years in PACU. Has 30 years experience. Sep 7, 2015 Honestly is looks like sinus rhythm with a notched p wave and a bundle branch blockAgree.PR int = 0.12 normalQRS = 0.12 delayed conduction, BBBRate approx 110There are no "F" waves present. Sinus Tach with BBB.
MendedHeart 663 Posts Sep 8, 2015 I'm not saying I'm right about the flutter, but if you zoom in really close, you can see extra p's in almost every lead. Also, there are a lot of sharp points throughout and the bottom lead looks like it a lot to me
AJJKRN 1,224 Posts Specializes in Medical-Surgical/Float Pool/Stepdown. Has 6+ years experience. Sep 8, 2015 I'm not saying I'm right about the flutter, but if you zoom in really close, you can see extra p's in almost every lead. Also, there are a lot of sharp points throughout and the bottom lead looks like it a lot to meI don't see any extra p's but I do see some artifact in some areas that could be mistook though. Flutter waves tend to be pretty sawtooth waves that will not change in polorization regardless of which lead you're looking at. (Or they will all be in the same direction anyways)http://www.registerednursern.com/wp-content/uploads/2008/11/a-flutter.gif
MendedHeart 663 Posts Sep 8, 2015 I don't see any extra p's but I do see some artifact in some areas that could be mistook though. Flutter waves tend to be pretty sawtooth waves that will not change in polorization regardless of which lead you're looking at. (Or they will all be in the same direction anyways)http://www.registerednursern.com/wp-content/uploads/2008/11/a-flutter.gifActually, they can be different directions in different leadsAtrial Flutter - Life in the Fast Lane ECG Library
ixchel 5 Articles; 4,547 Posts Specializes in critical care. Sep 8, 2015 I don't see any extra Ps either. QRS looks .08-.09 to me, so no BBB. If the P is inverted, then I'd call this junctional. I don't see it as notched.
Rhody34 128 Posts Specializes in Acute Care. Has 5+ years experience. Sep 9, 2015 I think people are reading way into this... I see SR...
