70 yo M with pmh DM and HTN presents with chest pain and a troponin of 41. STEMI code activated and patient taken to cath lab. Here is his EKG upon arrival:
1. What is this rhythm?
2. What is the treatment for this rhythm?
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eabram
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3 Comments
dzeccola · August 13, 2014 at 9:04 am
1) Junctional Rhythm
2) Treat the underlying ischemia. Also put pacer pads on the patient because this is a sign of poor cardiac automaticity and they may decompensate. That said don’t pace them now as long as their Junctional rhythm is perfusing.
jfreedman · August 14, 2014 at 5:21 am
junctional is reasonable without p waves….but why is it wide? when interpreting ecg’s, you’ve got to be comprehensive.
rate : 100
rhythm: regular, wide. no p waves. ventricular vs abberant junctional
axis: Left
intervals: wide QRS. no PR. normal QT
ST segments: no excessive discordance
q waves diffusely
DDx: Wide, regular, fast but not too fast. No p waves. DDx junctional with abberancy vs ventricular etiology, vs electrolyte vs tox. This is likely ventricular in etiology as there is no typical LBBB or RBBB ( long and insensitive criteria exist for discriminating between supraventricular with abberancy and ventricular)
In setting of recent MI, this is a reperfusion rhythm. This is benign and self-limited. treatment with electricity or anti-dysrhtmics can have disastrous consequences. Let it be.
1. accelerated idioventricular rhythm (not fast enough to call V tach)
2. Do nothing.
jfreedman · August 14, 2014 at 8:02 am
misspoke. doesnt necessarily have to be aberrant junctional. could be aberrantly conducted anything without p waves…