Not sure what to call this rhythm. A little help?

[fiznat]

27 y/o male complaining of opiate withdrawal symptoms. Hemodynamically stable. What would you call this rhythm?

Sorry, don't have a 12 lead available.

Edited June 9, 2009 by fiznat

[akroeze]

27 y/o male complaining of opiate withdrawal symptoms. Hemodynamically stable. What would you call this rhythm?

Sorry, don't have a 12 lead available.

Hmmmmm, I'll take a stab and risk looking like a fool.

The first three complexes are very regular, then we see what one could call a junctional escape, then the next 3 are pretty regular, then what looks like two more junctional escapes, not enough to say what the last complex is.

Although now that I look closer those escape beats COULD be wide depending on where you are saying the complex ends and the ST begins and they are certainly a different morphology at the very tail end of them so they could be ventricular in origin possibly.

If I had to give it a name I would call it Sinus with escape beats.

I know, not really definite but I gave it a shot!

[CBEMT]

Edit: nevermind, I see it now.

Edited June 10, 2009 by CBEMT

[AZCEP]

With the lack of regularity and no clearly discernible P-waves, I'm calling it Afib. Patient is a bit young, but anything is possible.

[FireMedic65]

Looks regular from the normal view on the forum, but zooming it, it's not regular. Can't determine P waves. I'm calling it AFIB as well.

[celticcare]

Looks like Afib with slight st depression starting, could be secondary to the opiate use, with occasional runs of Sinus in also.

[chbare]

Could be atrial fibrillation; however, I notice an every three complex pattern of significant irregularity. Three complexes are "fairly" regular, followed by an irregular complex. (PJC perhaps?) This does not fit nicely into the irregularly/irregular classification of atrial fibrillation.

Perhaps the underlying rhythm is atrial fibrillation, and these additional complexes are confusing the picture; however, I think it is worth considering other problems.

Was that ECG taken in a quite, stable environment? Was the patient shivering or moving? Is there anything that could be causing the wavy baseline? Clearly, I cannot identify any well defined P wave. On someone so young, I would want a XII lead, and would want to consider an electrolyte abnormality or perhaps endocarditis given the history of opiate abuse. (Injected opiate abuse?) Was the patient febrile? Were you able to obtain follow up?

Take care,

chbare.

Edited June 10, 2009 by chbare

[FireMedic65]

I would have to agree. Pretty hard to tell "for sure" without a 12 lead.

[crotchitymedic1986]

Just plain old Atrial Fib, what you are seeing as possible p's do not measure out. A longer strip could be useful to ensure that it is irregularly irregular throughout

[chbare]

Just plain old Atrial Fib, what you are seeing as possible p's do not measure out. A longer strip could be useful to ensure that it is irregularly irregular throughout

I am not seeing P waves. I specifically stated in an earlier post that I cannot identify any well defined P wave. If you twisted my arm and made me man up to an answer, I would say atrial fibrillation is the underlying rhythm with PJC's at this point.

Take care,

chbare.