EKG of the Week

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This patient is a 78 yo man who presented to PCP with 5 d hx dyspnea on exertion.

+ EKG Interpretation

Dr. Ohlbaum's Explanation

The EKG has P waves and QRS's but they are not related. The P waves march through at rate around 85. There are wide QRS's unrelated to those P waves at rate 38.

The atrial mechanism is sinus with regular, and normal looking P waves. There is complete heart block (3rd degree AV block) since none of the P's are conducted. Next, we need to decide where the escape is coming from. In a junctional escape the rate will usually be in S0's and the QRS narrow, whereas a ventricular escape will be in the 30's with a wide funny looking QRS.

This is complete heart block with ventricular escape.

He now has a pacemaker.

Further Reading:

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