|
Re: What is the diagnosis?
posted at 4/12/2011 5:14 PM GMT
on bmj.com
|
Posts: 873
First: 17/6/2011 Last: 17/5/2013 |
Thanks Joey R I'm humbled that you value my opinion! Alaminium some clinical details would be nice! I presume the upper trace is lead 2 and the lower trace is an augmented lead? I see a narrow QRS complex with retrograde P wavesand a long (by eye) corrected QT interval. Are we allowed to ask age, relevant drug history, time of recording , temperature/BP and clinical presentation? best sadian |
|
|
Re: What is the diagnosis?
posted at 4/12/2011 9:50 PM GMT
on bmj.com
|
|
Posts: 267
First: 2/8/2010 Last: 11/5/2013 |
Hello Docs This ECG question appeared in one of the Exam papers as :- What is the diagnosis ? , the upper trace is lead 2, the lower trace lead was not given, the examiners did not give any other data or clue ! Here are the MCQs :- (A) Normal sinus rhythm (B) Atrial Fibrillation (C) Sinus Tachycardia (D) Junctional escape rhythm (E) Accelerated Junctional rhythm As Sadian said the p waves are retrograde, I will add the rate is 80/min |
|
|
Re: What is the diagnosis?
posted at 5/12/2011 9:16 AM GMT
on bmj.com
|
|
Posts: 873
First: 17/6/2011 Last: 17/5/2013 |
Hi alaminium, sounds like you have very nice examiners!!!. In this case my answer is e acclerated junctional rhythm. Not a - the p waves are behind the QRS not b - the rhythm is regular c- not a tachycardia - definiton rate />100 and not sinus d - not junctional escape as the rate is too fast at 80 Who set the exam? sadian |
|
|
Re: What is the diagnosis?
posted at 18/12/2011 8:43 PM GMT
on bmj.com
|
|
Posts: 267
First: 2/8/2010 Last: 11/5/2013 |
The normal junctional escape rate is 40-60 bpm. A rate of 60-100 bpm is accelerated (This one is about 80 bpm). The retrograde P wave is normally hidden in the QRS or found immediately after it. Junctional rhythm describes an abnormal heart rhythm resulting from impulses coming from a locus of tissue in the area of the atrioventricular node,[1] the "junction" between atria and ventricles. Under normal conditions, the heart's sinoatrial node determines the rate by which the organ beats - in other words, it is the heart's "pacemaker." The electrical activity of sinus rhythm originates in the sinoatrial node and depolarizes the atria. Current then passes from the atria through the bundle of His, from which it travels along Purkinje fibers to reach and depolarize the ventricles. This sinus rhythm is important because it ensures that the heart's atria reliably contract before the ventricles. In junctional rhythm, however, the sinoatrial node does not control the heart's rhythm - this can happen in the case of a block in conduction somewhere along the pathway described above. When this happens, the heart's atrioventricular node takes over as the pacemaker.[2]. In the case of a junctional rhythm, the atria will actually still contract before the ventricles; however, this does not happen by the normal pathway and instead is due to retrograde conduction (conduction comes from the ventricles or from the AV node into and through the atria).[3]. Junctional rhythm can be diagnosed by looking at an ECG: it usually presents without a P wave or with an inverted P wave. Occasionally the P wave will be retrograde, meaning appearing after the QRS complex. [4] |
