{"id":651,"date":"2016-08-07T00:01:02","date_gmt":"2016-08-07T00:01:02","guid":{"rendered":"http:\/\/torreyekg.com\/?p=651"},"modified":"2016-08-04T14:42:46","modified_gmt":"2016-08-04T14:42:46","slug":"ekg-of-the-week-39","status":"publish","type":"post","link":"http:\/\/torreyekg.com\/index.php\/2016\/08\/07\/ekg-of-the-week-39\/","title":{"rendered":"EKG of the Week #39"},"content":{"rendered":"<p><a href=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/08\/39.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-652\" src=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/08\/39.png\" alt=\"39\" width=\"648\" height=\"368\" srcset=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/08\/39.png 648w, http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/08\/39-300x170.png 300w\" sizes=\"auto, (max-width: 648px) 100vw, 648px\" \/><\/a><br \/>\n64-year-old woman with intermittent lightheadedness.<\/p>\n<div class=\"spoiler-wrap\"><div class=\"spoiler-head collapsed\" title=\"Expand\">Answer &amp; Explanation<\/div><div class=\"spoiler-body\" style=\"display: none;\"><br \/>\nThe rhythm is the most important and possibly difficult thing to assess. The first three beats appear to be sinus at a rate of 50 beats\/minute.  The rhythm then abruptly changes rate to 33 beats\/minute.  This patient was symptomatic when she had long periods of a rate of 33\/minute.  One might assume sinus node dysfunction, but look closer\u2026\n<p><a href=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/08\/Screen-Shot-2016-08-04-at-9.40.09-AM.png\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/08\/Screen-Shot-2016-08-04-at-9.40.09-AM.png\" alt=\"Screen Shot 2016-08-04 at 9.40.09 AM\" width=\"868\" height=\"144\" class=\"alignnone size-full wp-image-653\" srcset=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/08\/Screen-Shot-2016-08-04-at-9.40.09-AM.png 868w, http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/08\/Screen-Shot-2016-08-04-at-9.40.09-AM-300x50.png 300w, http:\/\/torreyekg.com\/wp-content\/uploads\/2016\/08\/Screen-Shot-2016-08-04-at-9.40.09-AM-768x127.png 768w\" sizes=\"auto, (max-width: 868px) 100vw, 868px\" \/><\/a><br \/>\nThis rhythm strip demonstrates something deforming the terminal portion of the T wave that precedes the beats of the slower rate (arrows).  The deflect that deforms these T waves is a very early atrial beat, a premature atrial contraction (PAC), that is so early that the conduction system is not yet ready to accept a premature beat \u2013 thus what we see here is bradycardia simulated by blocked PACs occurring in a bigeminal pattern.<\/p>\n<p>Remember,<br \/>\nThe most common cause of a pause<br \/>\nin sinus rhythm is a blocked PAC!<\/p>\n<p><\/p><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>64-year-old woman with intermittent lightheadedness.<\/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-651","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\/651","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=651"}],"version-history":[{"count":2,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/651\/revisions"}],"predecessor-version":[{"id":655,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/651\/revisions\/655"}],"wp:attachment":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/media?parent=651"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/categories?post=651"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/tags?post=651"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}