What in the world is this rhythm?!

Specialties Critical

Published

I would really like to know as I cant find it in my EKG book which has 40 ekg rhythms...

I know it has very peaked P&T waves and a narrow QRS.

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Specializes in Hospice.

What I see is a short PR interval. I've never seen that clinically, but a google search reveals Lown-Ganong-Levine Syndrome.

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ECG interpretation isn't something you can learn by trying to memorize what a particular rhythm looks like. You need to learn the criteria for each individual rhythm, and then apply those criteria, using a consistent, systematic approach, to each strip you are evaluating.

When I analyze an ECG rhythm strip I use the following mnemonic: RRPPQQS.

Rate: What is the rate? Less than 60 or greater than 100? If an ectopic pacemaker site, is the rate less than or greater than the intrinsic rate for the pacemaker.

Regularity: Is the rhythm regular? If irregular, Is there a pattern to the irregularity?

P wave: Are P waves present? Is each P wave followed by a QRS complex?

PR interval: 0.12 - 0.2 seconds.

QRS complex: 0.06 - 0.1 seconds, although you will find some variation to these values.

QT/QTc interval: Some centers will have you measure, and correct for rate, the QT interval.

ST segment

For the rhythm you posted. Forget for the moment that the P and T waves appear peaked. Does this ECG tracing match the criteria for any rhythm?

If you aren't familiar with ECG interpretation, you might find the Life in the Fastlane ECG Library helpful.

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Sinus Bradycardia.

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I'm hoping to call it sinus bradycardia. But I could possibly see an anterior infarct or hyperkalemia. You'd need a 12 lead to see. Definitely at its base, sinus Brady.

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What I see is a short PR interval. I've never seen that clinically, but a google search reveals Lown-Ganong-Levine Syndrome.

Thats not a short pr interval. PR interval starts at the start of the p wave, not the end of it. And lown- ganong Levine is pretty rare (as far as I know) and not really diagnosed by the presence of a short pr interval in isolation but by a short pr interval in a patient having bouts pf unexplained tachycardia.

T waves are borderline peaked, but in absence of other issues or irregularities, I'd just call the rhythm sinus bradycardia and not give it too much more thought.

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Specializes in ICU.

Cowboyardee, my thoughts exactly. When I first saw this was simply a sinus rhythm, I thought it was a joke question.

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Cowboyardee, my thoughts exactly. When I first saw this was simply a sinus rhythm, I thought it was a joke question.

I was trying to figure out what I was missing/not seeing because I thought it looked like straight-up sinus brady :D

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Just out of curiosity, which lead is this?

It is sinus and it is slow.

The PR interval is within normal limits, but don't those P waves look very tall? With an amplitude of 0.5 mV, could this possibly be Right Atrial Enlargement?

Lung disease? Tricuspid stenosis?

I would love to see a 12-lead of this. Specifically, I would really love to see V1 and II.

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Specializes in Critical care.

Sinus brady 37 BPM .... nothing to see here people move along

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Sinus Brady

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...yeah, sinus brady, some kind of systemic inflammatory disease too, I think, might be bowel, can't be sure...troubled childhood...

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