Name the rhythm

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med109

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Saw this on Paramedics on Facebook. Lots of interesting answers. I thought I would see what everyone here says. No patient information, the poster said he said it was "this" and the Dr did not agree. The poster has yet to mention what him or the Dr thought the ryhthm to be.

This is a link to the facebook page https://www.facebook.com/#!/photo.p...16783680.50226.117877988247187&type=1&theater

And I added the rhythm as an attachment, not sure how to post the rhythm any other way, sorry
 

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Third degree heart block with a narrow qrs complex
 
Hmm, consistent PRI, so I'm not thinking 3rd degree. 2nd degree type II with 5:1 conduction. One P buried in the T for each complex. P waves are too slow to be atrial flutter.

Not that this is relevant, but I would absolutely expect this could rapidly deteriorate to a 3rd degree.
 
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I'm no TomB, Chase, or Christopher... But I'll take a stab. Atrial rate is floating around 200. PR seems to be fairly consistent. A Flutter with a Mobitz/Type 2 heart block.
 
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I always look forward to Tom or Christopher chiming in on these.
 
Atrial tach with Av block
 
PoeticInjustice said:
I'm no TomB or Christopher... But I'll take a stab. Atrial rate is floating around 200. PR seems to be fairly consistent. A Flutter with a Mobitz/Type 2 heart block.
Click to expand...

A flutter is one of the answers that was popping up. While I realize flutter isn't always going to be "sawtooth", I have a really hard time seeing those as anything but P waves. Is there a reason you see flutter?
 
PoeticInjustice said:
I'm no TomB, Chase, or Christopher...
Click to expand...

I am not worthy to be listed among those two but thanks anyway :D

I think you are on the right track. Think about the atrial rates for the various atrial arrhythmias
 
Chase said:
I am not worthy to be listed among those two but thanks anyway :D

I think you are on the right track. Think about the atrial rates for the various atrial arrhythmias
Click to expand...

All three listed are far better than I ;)

Yeah, I was just reading up on that when I saw your A Tach post. 240-400 for A Flutter; this doesn't seem to quite make it to that mark. A Tach is 100-250, if my sources are correct. Seems more reasonable.
 
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On a side note the strips shown are from a Philips telemetry monitor in "EASI" mode which is basically a derived 12 lead based off an algorithm using a modified 5 lead placement. It is meant to simulate a 12 lead but is not identical to an actual 12 lead and usually not considered diagnostic quality. Just something to keep in mind if things look a little off, especially expected amplitudes and morphologies.
 
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In a 3rd degree block, if the ventricular rate and atrial rate can match up on accident. If the ventricular rate is 40 and the atrial rate is 80, it may look like there is a consistent PRI because of how things march out.
 
I'm stumped...
 
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The atrial rate steps out as does the ventricular rate. 3AVB.
 
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