strange ekg

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iclause

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ok... my boss & i just finished taking care of a gentleman who is 65 with HTN of only medical condition. i am an intermediate & my boss is a paramedic. patient was brought to our office for a near syncope episode. original bp was 80/54 w/ pulse of 62. on a 3 lead ekg, showed a multipuple pvcs. the paitent took a deep breath & the montior went flat lined for approx 3-5 seconds. any ideas on what this is called?
 
If no P waves visible: Sinus Arrest or Sick Sinus Syndrome.

If P waves with a pattern before pause: SA Block.

If P waves without ventricular beats; High Grade AV Block.

A sinus pause can also occur with increased vagal stimulus with a deep breath.

Or, an electrode didn't make contact when the patient took a deep breath.
 
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would be nice to see the strip but agree it could be sinus pause.

I use to work in telemetry and would see it from time to time.
 
iclause said:
ok... my boss & i just finished taking care of a gentleman who is 65 with HTN of only medical condition. i am an intermediate & my boss is a paramedic. patient was brought to our office for a near syncope episode. original bp was 80/54 w/ pulse of 62. on a 3 lead ekg, showed a multipuple pvcs. the paitent took a deep breath & the montior went flat lined for approx 3-5 seconds. any ideas on what this is called?
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UPDATE: ok... here is an update on this gentleman. the monitor showed nsr w/ pvc every 3 beats. then when he took a nice deep breath the monitor would go flat lined for approx. 3-5 seconds.
 
PVC every third beat is ventricular trigeminy.

As Vent said, this could either be because a sticky dot came off or one of several types of block.

We would really need to see the ECG.
 
Sounds like ventricular trigeminy. If the asystolic moments were reproducible with each deep breath, chances are the patient has a sinus pause (which is what this sounds like) or the electrode isn't making contact. Did someone feel for presence/absence of a pulse when the patient took a deep breath? Does the patient know if that's normal for him?

What makes me suspicious is that this guy has a history of HTN and now has a pretty low BP (assuming that the cuff is correctly sized and whatnot). While the 3-lead is OK, I'd much rather see a 12 lead...
 
so... if the rhythm went

beat, beat, pvc... that's trigeminal pvc's

if it was

beat, beat, beat, pvc - then its quadrigeminy(al) pvc's (yes it exists)

also... with regard to the 3-5 second pause...if you had a P wave somewhere in the isoelectric line... its probably a non-conductive PAC. If it truly doesn't have a P wave... its either

sinus pause - less than 3 seconds

sinus arrest - 3 seconds or more without a normal sinus rhythm (pr, qrs, and qt interval)
 
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