Name the Rhythm

[mikeylikesit]

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.

 

[fma08]

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)

 

[DBieniek]

I'm not a paramedic, but based on the tent shaped T wave I'll throw hyperkalemia out there? ^_^

 

[mikeylikesit]

Rate (/min)75--QT (ms)398--pr (ms)169--QRS axis (degrees)444---QRS (ms)84

 

[fma08]

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?

 

[mikeylikesit]

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?

demand pacer walked in to the ER on his own. rapid and shallow breathing. weakness in the legs.

 

[fma08]

... i'm still waiting for someone to point me in the right direction, i'm out of ideas

 

[DBieniek]

I take it that my guess was incorrect?

 

[fma08]

nah you're probably right, he's got some electrolyte issues goin on there (hyperkalemia included)

 

[mikeylikesit]

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.

 

[fma08]

it is kinda fun, i can always use practice, this was a good idea

 

[DBieniek]

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.

 

[fma08]

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

 

[DBieniek]

Thanks for the advice man! I appreciate anything I can learn.

 

[fma08]

... so is it friday yet??

 

[mikeylikesit]

... so is it friday yet??

I think i will post the answer tomorrow 5 days does seem entirely too long!

 

[mikeylikesit]

The answer is supraventricular tachycardia with 2:1 block

 

[fma08]

i suppose the block accounts for the rate being only 75?

 

[Ridryder911]

or more commonly known as atrial tach with fixed block..

R/r 911

 

[DBieniek]

Could you explain the reason this is SVT?