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With P waves labeled — Isn't it now much easier to appreciate that the atrial rhythm is quite regular ( with no more than a slight sinus arrhythmia )? P utting I t A ll T ogether : The precise mechanism of today's arrhythmia is complex and difficult to determine. For those with a special interest in cardiac arrhythmias — READ ON! —
Looking first at the long-lead II rhythm strip — there is significant bradycardia , with a heart R ate just under 40/minute. But the point to emphasize — is that it should only take seconds to recognize that there is bradycardia from significant AV block. = Would you approve her for a nonemergent surgical procedure?
Whatever the specific etiology of today's arrhythmia is, the “good news” is — that this rhythm will most probably improve with reperfusion of the "culprit" artery. That said — I found today's arrhythmia fascinating, and worthy of more in-depth analysis. Using calipers facilitates the process.
That said — obvious findings include: i ) Marked bradycardia! — L addergram I llustration : At this point — I needed to work out, and then draw a laddergram that I could then verify to ensure a plausible mechanism for today's arrhythmia. The rhythm in Figure-1 is complex — and defies precise interpretation without careful study.
CMAJ 2014. Int J Cardiol 2014. == MY Comment by K EN G RAUER, MD ( 10/13/2022 ): == I suspect most cases of acute OMI that occur in association with WPW — are overlooked! Electrocardiography in the patient with the Wolff-Parkinson-White syndrome: diagnostic and initial therapeutic issues. Am J Emerg Med 1999. Chang and Liu.
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