Name the Rhythm

mikeylikesit

mikeylikesit

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Ok so here is the first installment of a game that is called name the rhythm. i thought it would be fun to do this as a game posting on Sunday and posting the answer on fridays. i would like it if we could trade off on sundays on who posts the rhythm. i see that a lot of people get into these on the site and would like to keep it going. so basically give a short description of the pt and vitals if available. i'll lead by example good luck. This is a 12 lead electrocardiogram from a 70 year old man with chest pain and palpitations on exertion. The patient was implanted with a Russian pacemaker 7 years ago for bradycardia.
ecgaf2.gif
 
since there's no "boxes" on there, can we get PRI, QRS duration, and such measurements? (yes i am a newbie, i still need to see some of that stuff)
 
I'm not a paramedic, but based on the tent shaped T wave I'll throw hyperkalemia out there? ^_^
 
Rate (/min)75--QT (ms)398--pr (ms)169--QRS axis (degrees)444---QRS (ms)84
 
well i'll be the first one to sound like an idiot... was thinking some sort of junctional first off due to inverted p waves... but the pri is kinda long... so i wouldn't think there'd be such a thing as 1'st degree block accelerated junctional... yeah the t's are peaked so probably some electrolyte imbalances there, is it a demand pacer? i'm seein some depression in I, aVL, V3 and V4. Pt. was asymptomatic at rest i take it? SOB? N/V? general weakness?
 
fma08 said:
well i'll be the first one to sound like an idiot... was thinking some sort of junctional first off due to inverted p waves... but the pri is kinda long... so i wouldn't think there'd be such a thing as 1'st degree block accelerated junctional... yeah the t's are peaked so probably some electrolyte imbalances there, is it a demand pacer? i'm seein some depression in I, aVL, V3 and V4. Pt. was asymptomatic at rest i take it? SOB? N/V? general weakness?
Click to expand...
demand pacer walked in to the ER on his own. rapid and shallow breathing. weakness in the legs.
 
... i'm still waiting for someone to point me in the right direction, i'm out of ideas
 
I take it that my guess was incorrect?
 
nah you're probably right, he's got some electrolyte issues goin on there (hyperkalemia included)
 
like said the answer will be posted on friday around 5:00 Pm Central. the point is to inform why you chose that if possible so that others can learn from you! and it is kind of fun for some of us.
 
it is kinda fun, i can always use practice, this was a good idea :)
 
Like I said guys, I am not a paramedic and I haven't even started paramedic school yet. I just pick the stuff up as I go along and try to read everything I can get my hands on.

Sorry if it feels like I'm stepping somewhere I shouldn't be.
 
nah, props to you man for trying to get a head start on it... just don't go too far till you get the basics down 100% rate, regularity, p-waves, PRI, QRS
 
Thanks for the advice man! I appreciate anything I can learn.
 
... so is it friday yet?? :P
 
The answer is supraventricular tachycardia with 2:1 block
 
i suppose the block accounts for the rate being only 75?
 
or more commonly known as atrial tach with fixed block..

R/r 911
 
Could you explain the reason this is SVT?
 
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