ECG for discussion

[BEorP]

Hopefully the attachment works! Sorry that the quality isn't magnificent. I am interested in hearing thoughts on the rhythm since this generated a bit of discussion.

Basic clinical details: 67 year old female complaining of chest pain radiating into her back with associated shortness of breath. Reports a history of a previous MI and angina.

Thoughts?

Edited March 12, 2014 by BEorP

[Caduceus]

I'm not a medic, but what's with all the flattened P-waves? is that what I am looking at?

[jwiley40]

The P waves look inverted. Tells me it's junctional. It's not a great attachment but I could see the inverted waves. Other than that, regular rhythm

[scubanurse]

Rate looks borderline for a junctional rhythm though... I see no p-waves but I can also see where you think they're inverted.

[jwiley40]

If you look at the Lead II rhythm at the bottom of the attachment, the inverted P waves are there. I agree though. they are hard to see.

[Caduceus]

Okay, so P-waves are related with the atria, right? So what does it mean when they're 'inverted'?

[scubanurse]

you tell us research is your friend!

And yes, p-waves have to do with the atria, but what about the atria??

Edited March 31, 2014 by scubanurse

[Caduceus]

Okay, so the P-wave is when the atria contract, or atrial polarization.

If it's inverted it could mean a premature heart beat, or that the atria aren't contracting.

Is this a precursor of an MI?

[ERDoc]

EKGs only tell you about the electrical state of the heart, so it would not tell you anything about contraction or relaxation of the myocardium. Are you sure about that polarization thing?

[Caduceus]

Hmm...let me read some more on it, Doc, and I'll see what I can come up with.