jedirye
Forum Lieutenant
- 114
- 0
- 0
Curious what you guys think. I can divulge more information a bit later, just curious to see what you guys are thinking at this point without any clues (ie. signs/symptoms).
Been meaning to post this strip for a while...
- Thread starter jedirye
- Start date
DrankTheKoolaid
Forum Deputy Chief
- 1,344
- 21
- 38
re
mobitz 2, aka 2nd degree type 2, hell maybe even a 3rd now that i march it out
mobitz 2, aka 2nd degree type 2, hell maybe even a 3rd now that i march it out
Last edited by a moderator:
Melbourne MICA
Forum Captain
- 392
- 13
- 18
Strip
Its slow so brady. P waves are consistently attached to QRS and have same morphology so no AV dissociation and sinus node focus. Looks like every second beat is not coducted so that makes it a:
Sinus Bradycardia with 1:1 Mobitz Type 2 2nd degree AV block
I think......
Why can't we just say - its going slow because some of the cylinders aren't working properly cause the fuel injectors are clogged.
MM
Its slow so brady. P waves are consistently attached to QRS and have same morphology so no AV dissociation and sinus node focus. Looks like every second beat is not coducted so that makes it a:
Sinus Bradycardia with 1:1 Mobitz Type 2 2nd degree AV block
I think......
Why can't we just say - its going slow because some of the cylinders aren't working properly cause the fuel injectors are clogged.
MM
OP
OP
jedirye
Forum Lieutenant
- 114
- 0
- 0
Dispatched as N/V with abdominal pain. 42 Y/W/F pt sitting on toilet (seat down, thank God) actively vomiting into trash bucket. Pt states that she's been vomiting for two days straight, almost to the point of dry heaving. Blood glucose elevated to 300mg/dL, no hx of diabetes. VS as stated. Rhythm as posted. Denies any shortness or breath, chest pain, or otherwise any other discomfort except as noted above (abdominal pain).
Update later after lab results, potassium at 2.8mEq/L.
Update later after lab results, potassium at 2.8mEq/L.
DrankTheKoolaid
Forum Deputy Chief
- 1,344
- 21
- 38
re
Actually regardless of the regularity of the normal appearing P waves. Pay close attention to the notching. Not only is it not typical, that notched impulse follows a secondary pattern of regularity through out the entire strip. Im still going with a block but this looks extremely similar to a Primary Aflutter with variably conducted ventricular beats
Corky
Actually regardless of the regularity of the normal appearing P waves. Pay close attention to the notching. Not only is it not typical, that notched impulse follows a secondary pattern of regularity through out the entire strip. Im still going with a block but this looks extremely similar to a Primary Aflutter with variably conducted ventricular beats
Corky
TomB
Forum Captain
- 393
- 82
- 28
Yup! Thought so. Hypokalemia causes QT prolongation and the appearance of U waves. I don't think this is 2AVB.
Tom
usually wont you have a wide QRS with this also?
OP
OP
jedirye
Forum Lieutenant
- 114
- 0
- 0
Once again, credit to Dr. Dubin.
so lets talk signs of hypokalemia on an EKG. First the QRS widens, then your ST segment starts to depress, your T wave begins to flatten out, then you develop a U wave. The more and more hypokalemic they become the bigger your U wave gets and the smaller your T wave gets.
Now lets talk what we see on the EKG as far as those are concerned......No wide QRS...machine says it is 0.088 and if you dont trust that then just look at them all....next ST depression, I dont see any of that either. Flattened T wave....maybe slightly in some strips but not enough to get me thinking hypokalemia with all the other signs absent. Now the U wave....you can argue that there is something after the T wave but you cant distinguish between a P wave and T wave.....so with all the other signs absent I would assume that those are P waves not T.
Had you not been told that there serum potassium level was 2.8 I doubt any of you would be thinking hypokalemia...neither would I. So interpreting that you could either come up with a 2:1 2nd degree Type 2, or a 3rd degree.
As far as QT prolongation......the QT is still within normal limits
And as if that werent enough the skips (missing QRS's) are not accounted for by the hypokalemia theory.
If anyone has evidence to dispute this please let me know cause I am very intrigued by this and would love all the education I can get
Now lets talk what we see on the EKG as far as those are concerned......No wide QRS...machine says it is 0.088 and if you dont trust that then just look at them all....next ST depression, I dont see any of that either. Flattened T wave....maybe slightly in some strips but not enough to get me thinking hypokalemia with all the other signs absent. Now the U wave....you can argue that there is something after the T wave but you cant distinguish between a P wave and T wave.....so with all the other signs absent I would assume that those are P waves not T.
Had you not been told that there serum potassium level was 2.8 I doubt any of you would be thinking hypokalemia...neither would I. So interpreting that you could either come up with a 2:1 2nd degree Type 2, or a 3rd degree.
As far as QT prolongation......the QT is still within normal limits
And as if that werent enough the skips (missing QRS's) are not accounted for by the hypokalemia theory.
If anyone has evidence to dispute this please let me know cause I am very intrigued by this and would love all the education I can get
DrankTheKoolaid
Forum Deputy Chief
- 1,344
- 21
- 38
re
Yeah im not going with the hypokalemia on this as there is just to much else going on. Im certainly not even trained in EKG other then what we learned in medic school and what i've read on my own. But after some more reading on hypokalemia this certainly doesnt fit. It doesn't account for the secondary rhythm which can be marched out as notches along the entire length of the strips.
Yeah im not going with the hypokalemia on this as there is just to much else going on. Im certainly not even trained in EKG other then what we learned in medic school and what i've read on my own. But after some more reading on hypokalemia this certainly doesnt fit. It doesn't account for the secondary rhythm which can be marched out as notches along the entire length of the strips.
i definitely agree.....even tho the hypokalemia leads to an interesting diagnosis....im thinking the way it marches out would definitely point towards a 2:1 Mobitz.....either way the lesson learned is dont always trust what your machine says as far as rhythm interpretation. it said a mobitz 1.....it definitely is not
Melbourne MICA
Forum Captain
- 392
- 13
- 18
another look
I try to look at the clearest part of any ECG. Strips with atifact are not reliable. So the original 12lead in leads II,III, V4-V6 are nice and clean. They show a clear sinus beat and a p wave march mapped out that has each second beat not conducted. I dont beleive these are U waves nor do i think its a flutter as the rate is wrong - 50bpm. Flutters should be multiples of 75yes?
The other feature is that somesinus beats are coming in early. The progression thus is p wave, QRS, p wave, no QRS etc. But the early beats are bugging me. Perhaps another atrial focus that is also kicking in from time to time?
Why did this poor woman endure two days of nausea and vomiting without seeking help?
I still reckon its a second degree block.
MM
I try to look at the clearest part of any ECG. Strips with atifact are not reliable. So the original 12lead in leads II,III, V4-V6 are nice and clean. They show a clear sinus beat and a p wave march mapped out that has each second beat not conducted. I dont beleive these are U waves nor do i think its a flutter as the rate is wrong - 50bpm. Flutters should be multiples of 75yes?
The other feature is that somesinus beats are coming in early. The progression thus is p wave, QRS, p wave, no QRS etc. But the early beats are bugging me. Perhaps another atrial focus that is also kicking in from time to time?
Why did this poor woman endure two days of nausea and vomiting without seeking help?
I still reckon its a second degree block.
MM
DrankTheKoolaid
Forum Deputy Chief
- 1,344
- 21
- 38
re
Not so on the flutter, i had an interesting A-flutter about 2 weeks ago. Rate of 64 but irregular. I actually called it a 2nd type 1. Cardiologist i brought the patient to called it a A flutter with a 2-1 pre-weinkeback. What i suspected were U wave were actually a flutter wave.
http://books.google.com/books?id=_v...X&oi=book_result&ct=result&resnum=2#PPA416,M1
this link will bring you to almost a mirror of my patients strip.
Corky
Not so on the flutter, i had an interesting A-flutter about 2 weeks ago. Rate of 64 but irregular. I actually called it a 2nd type 1. Cardiologist i brought the patient to called it a A flutter with a 2-1 pre-weinkeback. What i suspected were U wave were actually a flutter wave.
http://books.google.com/books?id=_v...X&oi=book_result&ct=result&resnum=2#PPA416,M1
this link will bring you to almost a mirror of my patients strip.
Corky
Melbourne MICA
Forum Captain
- 392
- 13
- 18
Flutterrrrrrrrr
Corky
I couldn't load the page you mentioned but did a quick google to the American heart Association page on flutter.
Here's the link:http://www.americanheart.org/presenter.jhtml?identifier=52
Your's is an interesting take on the strip. I still think it's too slow (the p wave rate ) to be flutter but will stand corrected. Here to keep learning after all.
MM
Corky
I couldn't load the page you mentioned but did a quick google to the American heart Association page on flutter.
Here's the link:http://www.americanheart.org/presenter.jhtml?identifier=52
Your's is an interesting take on the strip. I still think it's too slow (the p wave rate ) to be flutter but will stand corrected. Here to keep learning after all.
MM