Been meaning to post this strip for a while...

[DrankTheKoolaid]

re

oh me also mica, that's why i love these discussions. Keep's me from pigeon holing myself into specific thought patterns. Link didnt work eh?

type this into google, third link down


"a flutter wenckebach"

 

[omak42]

but does anyone see any sort of wave that would lead you to think a flutter?

i have to agree with corky...very interesting these things are

 

[Melbourne MICA]

The plot thickens

oh me also mica, that's why i love these discussions. Keep's me from pigeon holing myself into specific thought patterns. Link didnt work eh?

type this into google, third link down


"a flutter wenckebach"

Thanks Corky - looks like plate 469 was the one you were looking at. Pretty close match. I haven't had a chance to explode the view for a closer look or read the text yet but looks like the plot thickens. All good stuff nicht wah?

MM

 

[TomB]

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.

There's no doubt in my mind that they are U waves.

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.

Actually, you should immediately consider hypokalemia for any patient with vomiting or diarrhea x2 days. I suspected hypokalemia when I saw the ECG and the story confirmed it (for me). It's always a good idea to interpret an ECG in light of the history and clinical presentation. The most likely explanation is usually correct. Sometimes I look for zebras, but that's when the clinical picture doesn't lend itself to an obvious answer.

As far as QT prolongation......the QT is still within normal limits

The computer is not measuring the QT interval correctly.

And as if that werent enough the skips (missing QRS's) are not accounted for by the hypokalemia theory.

Don't read too deeply into the irregularity. With 2AVBII the "skipped" beat would be 2x the previous R-R.

 

[maxwell]

Yup! Thought so. Hypokalemia causes QT prolongation and the appearance of U waves. I don't think this is 2AVB.

Tom

I'm going to give an Amen to Mobitz II.

(i) This rhythm may (or may not) present with a wide QRS [which is an ominous sign] - either way, they will need to be paced if this isn't from some weird drug toxicity (lopressuh, dig, dilt, etc)

(ii) The hypokalemia shouldn't make us that worried right now. People don't arrest dead in front of us from a low K+. (Now, Mg++, that's a different story) - but yes - it does present with a long QT. This isn't a long enough QTc to make us worry that the french are coming...

 

[TomB]

I, for one, would worry that the "french were coming" with a QTc = or > 500 ms! At least, I wouldn't be surprised! It would certainly modify my treatment plan for poly VT.

Tom

I'm going to give an Amen to Mobitz II.

(i) This rhythm may (or may not) present with a wide QRS [which is an ominous sign] - either way, they will need to be paced if this isn't from some weird drug toxicity (lopressuh, dig, dilt, etc)

(ii) The hypokalemia shouldn't make us that worried right now. People don't arrest dead in front of us from a low K+. (Now, Mg++, that's a different story) - but yes - it does present with a long QT. This isn't a long enough QTc to make us worry that the french are coming...

 

[jedirye]

Anyone else?

 

[DrankTheKoolaid]

re

hrmm was hoping a expert would pipe in also.