{"id":480,"date":"2016-02-21T00:01:58","date_gmt":"2016-02-21T00:01:58","guid":{"rendered":"http:\/\/torreyekg.com\/?p=480"},"modified":"2016-02-16T03:39:57","modified_gmt":"2016-02-16T03:39:57","slug":"ekg-of-the-week-20","status":"publish","type":"post","link":"http:\/\/torreyekg.com\/index.php\/2016\/02\/21\/ekg-of-the-week-20\/","title":{"rendered":"EKG of the Week #20"},"content":{"rendered":"<p><a href=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/20.png\" rel=\"attachment wp-att-481\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-481 size-full\" src=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/20.png\" alt=\"20\" width=\"648\" height=\"372\" srcset=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/20.png 648w, http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/20-300x172.png 300w\" sizes=\"auto, (max-width: 648px) 100vw, 648px\" \/><\/a><br \/>\nElderly woman with generalized weakness x 2 days.<\/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 \/>\nThis EKG reveals a regular rhythm at 30\/minute. There are no obvious P waves, although there appears to be irregular fine oscillations of the baseline, consistent with fibrillatory waves. Why would atrial fibrillation<br \/>\npresent with a slow and regular ventricular response? Perhaps these ventricular beats are escape beats, occurring because the AV node is completely blocked! This is what complete heart block occurring with atrial fibrillation looks like\u2026\n<p>If this patient was taking digoxin it would certainly be important to check a level to rule out toxicity. Digoxin toxicity classically causes two important EKG findings: 1) significant AV block (more than 1\u00b0 AV block), and 2) increased automaticity (often accelerated junctional rhythm or atrial tachycardias). Typically these two EKG findings occur simultaneously \u2013 hence the classic dig toxic rhythms (PAT with block or \u201cregularization\u201d of the a fib due to 3\u00b0 AV block with accelerated junctional escape rhythm).<\/p>\n<p>PAT with 2:1 block (P waves at 150\/minute \u2013 too slow for flutter waves, so these are discrete P waves and this is atrial tachycardia)<br \/>\n<a href=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/201.png\" rel=\"attachment wp-att-482\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-482\" src=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/201.png\" alt=\"201\" width=\"432\" height=\"96\" srcset=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/201.png 432w, http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/201-300x67.png 300w\" sizes=\"auto, (max-width: 432px) 100vw, 432px\" \/><\/a><\/p>\n<p>Another <strong>PAT<\/strong> (look hard for the P waves at 150\/minute) with <strong>2\u00b0 AV block, type I<\/strong><br \/>\n<a href=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/202.png\" rel=\"attachment wp-att-483\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-483\" src=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/202.png\" alt=\"202\" width=\"432\" height=\"86\" srcset=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/202.png 432w, http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/202-300x60.png 300w\" sizes=\"auto, (max-width: 432px) 100vw, 432px\" \/><\/a><\/p>\n<p>\u201c<strong>Regularization of atrial fib<\/strong>\u201d \u2013 due to accelerated junctional rhythm at 70\/minute with 3\u00b0 heart block of underlying a fib (note fibrillatory waves in V<sub>1<\/sub>)<br \/>\n<a href=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/203.png\" rel=\"attachment wp-att-484\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-484\" src=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/203.png\" alt=\"203\" width=\"432\" height=\"51\" srcset=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/203.png 432w, http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/02\/203-300x35.png 300w\" sizes=\"auto, (max-width: 432px) 100vw, 432px\" \/><\/a><br \/>\n<\/p><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Elderly woman with generalized weakness x 2 days.<\/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-480","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\/480","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=480"}],"version-history":[{"count":2,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/480\/revisions"}],"predecessor-version":[{"id":486,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/480\/revisions\/486"}],"wp:attachment":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/media?parent=480"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/categories?post=480"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/tags?post=480"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}