Double 'P' waves?!?

[Dustdevil]

The chances of her having a true LBBB, or an MI for that matter, are slim.

Spoken like a man who knows a thing or two about Slim!

[ERDoc]

But doc, it could happen you know. Stranger things have happened.

I'm not saying it can't happen or that it hasn't happened, but think horses not zebras.

[crazycanuck]

http://www.ncbi.nlm.nih.gov/entrez/query.f...p;dopt=Abstract

www.blackwell-synergy.com/doi/pdf/10.1111/j.1540-8167.1997.tb01021.x

http://circ.ahajournals.org/cgi/content/abstract/58/6/1036

http://www.circ.ahajournals.org/cgi/conten...act/103/25/3092

Had this lady had any PMH of an ablation procedure for arrhythmia?

[ERDoc]

Spoken like a man who knows a thing or two about Slim!

Yes, I do and here is the real Slim Shady:

[sledogg1]

God i love this site, Shane thanks for the refresher as well ER Doc. Did u do a stroke test on her...........no smart coments :oops: as a pre sycope????? could this be a sign of a possible CVA in the works, smoker???? drink??? meds legal or not birth control etc. Interesting.

[Dooger]

Sorry gang, got sidelined in the E/R for a couple days. Still recovering so replies could be slow.

sledogg1:

Neuro checks were all good, no hx of CVA :wink: , no predisposition except for smoking (<1 pk/day) and social drinker. No meds, rec or rx. If memory serves me correct she possibly had a vagal response after having a BM, but details are getting a little foggy though and my partner couldn't shed any more light on it. I also checked the LP-12 archives and it appears to have been bumped already (sorry).

I'm wonderin if we just stumbled on an interatrial block and it had us befuddled... until Shane & ERDoc pointed me in the right direction. On top of that I learned a thing or two about biphasic P-waves and p-mitrale while I was at it!

I think I'll file the PID dx for something anatomically lower, maybe cranial-rectal inversion syndrome, and a slightly modified treatment plan (we don't have the luxury of helo evac).

[notsobuff]

Your first "p" wave could have in fact been a U wave.

[als_medic_uk]

That sounds like a P wave with a PR interval prolongation, if you think of a junction being blocked [a short escape interval] then the next junction or conducted P wave would be shorter due to the block in the escaping QRS complex, and in turn a shorter PR interval. Ending up with two P waves, at the “R” junction blockage.

Reagrds

[Dooger]

Isn't that pretty much what an interatrial block is?

BTW: You better slow down on your education... you get many more letters after your name & you'll have to get your own alphabet!

[ERDoc]

Sorry to dig up a dead post, but somehow I got to thinking about this. Another cause of multiple P waves is a heart transplant. When they remove the old heart, they leave in old SA node. The new heart comes with a new SA node. So, you get two p waves.