Rhythm debate

Posted

This rhythm is being debated currently.

Any thoughts???

Edited by MendedHeart

AJJKRN

Specializes in Medical-Surgical/Float Pool/Stepdown. Has 6+ years experience. 1,224 Posts

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?

dianah, ADN

Specializes in Cath Lab/Radiology. Has 47 years experience. 9 Articles; 3,084 Posts

PR = normal = sinus rhythm

QRS = 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

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

2,046 Posts

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

Could it be a F wave on a t wave making look like STE? Flutter does break the isoelectric line?

Mavrick, BSN, RN

Specializes in 15 years in ICU, 22 years in PACU. Has 30 years experience. 1,578 Posts

Honestly is looks like sinus rhythm with a notched p wave and a bundle branch block

Agree.

PR int = 0.12 normal

QRS = 0.12 delayed conduction, BBB

Rate approx 110

There are no "F" waves present.

Sinus Tach with BBB.

MendedHeart

663 Posts

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

Specializes in Medical-Surgical/Float Pool/Stepdown. Has 6+ years experience. 1,224 Posts

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

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.gif

MendedHeart

663 Posts

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.gif

Actually, they can be different directions in different leads

Atrial Flutter - Life in the Fast Lane ECG Library

ixchel

Specializes in critical care. 5 Articles; 4,547 Posts

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

Specializes in Acute Care. Has 5+ years experience. 128 Posts

I think people are reading way into this... I see SR...