EKG reading question

[mshow00]

Im not sure if I'm posting this in the right place, so I applogize if you all have to move this:

That said I have a question about EKGs, one of the medics I work with had a strip off a 3 lead that showed a wide complex with a pacer spike right before (absolutly no space between them) no "P" or "T" waves present. I regretably do not have a copy of the strip, so you kinda have to take my word for it. It was paced at over 100 bpm (i believe) and I know nothing of the pts c/c or presentation. Is this a paced V-tach or some kind of block after the pacer?

[TheOldMan]

Is this what you were trying to describe?

[mshow00]

yeah thats it

[Kaisu]

That is typical of the VVI pacemakers that have one wire threaded (usually) through the tricuspid valve and is up against the wall of the septum in the right ventricle. There are no P waves, etc. because the atrium is not firing. Depolarization is initiated in the ventricles. The wide, bizarre QRS complex is always a sign of ectopic beats originating in the ventricles. This is this patient's normal rhythm. If you didnt see the pacemaker spikes, you might assume something dumb and treat it. Be careful because in the newer pacemakers, those spikes can be hard to spot. (The dead giveaway is a lump in the patient's chest - its not a tumor )

[TheOldMan]

I was trying to visualize what he was describing, that was the only thing I could think of.

[zzyzx]

It can be confusing when you see a pacemaker pacing at rates above 100. But you'll always know it's a pacer rhythm and not VT if you see pacemaker spikes. Note that on some monitors, like the Lifepak 12's that we use, you won't never see pacer spikes until you set the monitor to mark them.

[celticcare]

It seems to be pacemaker and also WPW season at work at the moment. We have four types of monitors in my unit and each picks up different spikes, as in sometimes they are small, some are big, and some wont pick them up unless pacing is set on the monitor.

KNow your gear, and enlarge the ECG size if necesary or change a lead.

[Arizonaffcep]

Short little story: I was working an overtime shift in south Scottsdale, when we get called for a CP. Pt is elderly gentleman who has a pacer, but no defibrillator. Not once, but twice he went into V-Tach around 180...his pacer kicked in...overdrove it at a rate of damn near 300, and backed it down to the 70's. Coolest thing I've seen in a while. I've done it with external pacing, but never seen it with an implanted pacer.

[Arizonaffcep]

It seems to be pacemaker and also WPW season at work at the moment. We have four types of monitors in my unit and each picks up different spikes, as in sometimes they are small, some are big, and some wont pick them up unless pacing is set on the monitor.

KNow your gear, and enlarge the ECG size if necesary or change a lead.

Where do you see the WPW? I would call this a standard paced rhythm...a wide qs leading into slightly elevated st segment with a large t wave. Fairly indicative of cardiac damage (previous). This is the same reason that the best indicator for an MI with a pacer is not necessarily a 12 lead, but the troponin.

[Texman]

That is a textbook paced rhythm. The one mshow00 was talking about is a paced rhythm but the pacer was in overdrive. I've seen that several times. There is really nothing you can do about it either. Pacers go into overdrive at times and it gives the same S&S as regular Tachycardia but the typical protocals won't do much for them.