What's the rhythm?

[spenac]

How come none of the know it all posters on here who know everything else in EMS haven't given their opinion on it yet?

I did give my opinion.

I would like some more experienced including the docs to break this one down for. Sincerely lost student.

[chbare]

P waves all over the place, irregular rhythm, possible digoxin effect (characteristic "ice cream scoop" pattern), atrial fibrillation until proven otherwise. IMHO.

Take care,

chbare.

[scott33]

P waves all over the place, irregular rhythm, possible digoxin effect (characteristic "ice cream scoop" pattern), atrial fibrillation until proven otherwise. IMHO.

Take care,

chbare.

Surely an a-fib that contains discernible P-waves, cannot be called "A-fib"

[Mateo_1387]

Look again at the PRI and shape of the p-waves, particularly on lead II and III on the 12-lead trace. Nothing is the same - variable PRI, notched P-waves, pointed P-waves, biphasic P-waves, retrograde P-waves etc.

Perhaps the OP can scan it a little larger for those in doubt.

The underlying rhythm appears to originate from the sinus node. There also appear to be ectopic atrial contractions. This may be why it looks like WAP or MAT. Take a look at the XII lead. There are plenty of similar p-waves, and the occasional biphasic and inverted p-wave, indicative of ectopic atrial contractions. I am sticking with my guns, I think it is more of a sinus arrhythmia, or even a sinus block (meaning the ectopic atrial contractions may be compensatory). Does this person have sick sinus syndrome?

[chbare]

Surely an a-fib that contains discernible P-waves, cannot be called "A-fib"

If you think there are discernible P waves for the QRS complexes. This is my take on the rhythm, you can agree or disagree. Obviously, we disagree. As the OP stated, three docs gave three different impressions.

Take care,

chbare.

[FireMedic65]

There are definitely P waves. Some are upright, some are inverted, and some have the top hat look to them.

[ERDoc]

I'm calling it MAT. We have clear P-waves before each QRS so it is not afib. I can see at least 3 different p wave morphologies with differing PR intervals. Based on this we can eliminate sinus arrhythmia. Mateo, you said, "the occasional biphasic and inverted p-wave, indicative of ectopic atrial contractions." This is exactly why it is WAP/MAT and not a sinus arrythmia. In SA your impulses are originating at the SA node, just at variable rates. It is the ectopic foci which give rise the WAP/MAT.

[Richard B the EMT]

The rate.

MAT = >100, WAP = <100

Now, for the BLS dude (that would be me), what do MAT and WAP stand for?

[scott33]

Now, for the BLS dude (that would be me), what do MAT and WAP stand for?

MAT = Multifocal Atrial Tachycardia

WAP = Wandering Atrial Pacemaker

[Mateo_1387]

I'm calling it MAT. We have clear P-waves before each QRS so it is not afib. I can see at least 3 different p wave morphologies with differing PR intervals. Based on this we can eliminate sinus arrhythmia. Mateo, you said, "the occasional biphasic and inverted p-wave, indicative of ectopic atrial contractions." This is exactly why it is WAP/MAT and not a sinus arrythmia. In SA your impulses are originating at the SA node, just at variable rates. It is the ectopic foci which give rise the WAP/MAT.

Thanks Doc, but why can't it be arrhythmia with PAC's. Take a look at the XII lead, there are clearly what appear to be round upright p-waves. I was under the impression that WAP and MAT all have different P-wave morphologies as well as varying PRI. The rhythms he showed us have Complexes that are regular, as well as some that are premature and late with varying p-wave morphologies.