{"id":462,"date":"2016-02-11T03:16:19","date_gmt":"2016-02-11T03:16:19","guid":{"rendered":"http:\/\/torreyekg.com\/?p=462"},"modified":"2016-02-11T03:18:29","modified_gmt":"2016-02-11T03:18:29","slug":"ekg-of-the-week-18","status":"publish","type":"post","link":"http:\/\/torreyekg.com\/index.php\/2016\/02\/11\/ekg-of-the-week-18\/","title":{"rendered":"EKG of the Week #18"},"content":{"rendered":"<p><a href=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/18.png\" rel=\"attachment wp-att-463\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-463 size-full\" src=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/18.png\" alt=\"18\" width=\"647\" height=\"360\" srcset=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/18.png 647w, http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/18-300x167.png 300w\" sizes=\"auto, (max-width: 647px) 100vw, 647px\" \/><\/a><br \/>\n45-year-old man with 2 hours of chest pain and diaphoresis.<br \/>\n(Pay special attention to the rhythm strip).<\/p>\n<div class=\"spoiler-wrap\"><div class=\"spoiler-head collapsed\" title=\"Expand\">Interpretation &amp; Explanation<\/div><div class=\"spoiler-body\" style=\"display: none;\"><br \/>\nLooking at the V1 rhythm strip, the first five beats are an accelerated idioventricular rhythm (no P waves, wide complex, and regular rate of 70\/minute). Just before the 6<sup>th<\/sup> beat you can see the \u201cemergence\u201d of a P wave \u2013 this particular P wave is very close to the subsequent QRS, and there is slight variation in the QRS morphology. The 6<sup>th<\/sup> QRS represents a fusion beat (a composite between the ventricular beat and a sinus-conducted beat occurring at nearly the same time). The 7<sup>th<\/sup> through 9<sup>th<\/sup> beats appropriately follow P waves and represent sinus conducted beats. This rhythm represents isorhythmic competition between <strong>accelerated idioventricular beats<\/strong> and sinus beats occurring at nearly the same rate.\n<p><a href=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/Screen-Shot-2016-02-10-at-10.15.09-PM.png\" rel=\"attachment wp-att-465\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-465 size-full\" src=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/Screen-Shot-2016-02-10-at-10.15.09-PM.png\" alt=\"Screen Shot 2016-02-10 at 10.15.09 PM\" width=\"482\" height=\"81\" srcset=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/Screen-Shot-2016-02-10-at-10.15.09-PM.png 482w, http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/Screen-Shot-2016-02-10-at-10.15.09-PM-300x50.png 300w\" sizes=\"auto, (max-width: 482px) 100vw, 482px\" \/><\/a><\/p>\n<p>The reason for this rhythm in this patient is apparent from leads V1-3 (the sinus conducted beats, so they can be interpreted) \u2013 the patient is having an <strong>acute anterior MI<\/strong>. Periods of accelerated idioventricular rhythm are common during acute infarction and especially during reperfusion following thrombolysis.\u00a0\u00a0 AIVR has also been termed nonparoxysmal ventricular tachycardia or \u201cslow v. tach\u201d. It usually does not produce any hemodynamic change, and requires no specific treatment.<\/p>\n<p><\/p><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>45-year-old man with 2 hours of chest pain and diaphoresis. (Pay special attention to the rhythm strip).<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-462","post","type-post","status-publish","format-standard","hentry","category-ekg-of-the-week"],"_links":{"self":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/462","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/comments?post=462"}],"version-history":[{"count":2,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/462\/revisions"}],"predecessor-version":[{"id":467,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/462\/revisions\/467"}],"wp:attachment":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/media?parent=462"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/categories?post=462"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/tags?post=462"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}