EKG of the Week

4-23 EKG_Page_1.jpg

+ EKG Interpretation

Dr. Ohlbaum's Explanation

First of all, the computer read this as an "Accelerated Junctional Rhythm". Is it? What would that look like? An accelerated junctional rhythm, is coming from the AV node, rate 70-130 which this is. But it is REGULAR, and there would be no Pora retrograde P right after every QRS. Is that what we are looking at here? Clearly not, DO NOT BE MISLEAD BY A COMPUTER!

So, let's look at this EKG. At quick glance is it regular? Well, sort of but there is an obvious spot near end where it is not. Are there P waves? There are clear P waves, marching thru the entire EKG perfectly regularly (I marked them on copy on other side). Are there QRS complexes after the P waves? Sometimes, but not always (see that spot near end of EKG). So this is sinus rhythm with 2nd degree AV block (some Ps conducted and some are not). Is it Mobitz I or II? Well, it takes a long time to get to point where QRS is dropped so you need to measure carefully. The PR right after the dropped beat is short, and if you start at the beginning of the tracing the PR gets gradually longer especially in the beats before the dropped QRS. So this is 2nd degree AV block Mobitz 1.

The QRS complexes are otherwise normal- normal amplitude, normal duration, no Qs where there should not be Qs. He has a generally "saggy" ST and flat T, so nonspecific ST and T changes

Overall reading: sinus rhythm with 2nd degree AV block, Mobitz 1 and nonspecific ST and Ts

Further Reading:

Follow up EKGs:

Full EKG Index