--- In ekg_club@yahoogroups.com, "jesse12848" <jesse12848@...> wrote:
>
> --- In ekg_club@yahoogroups.com, Nikiah Nudell <medicnick@> wrote:
> >
> > Hi Jesse,
> > I just wanted to clarify something you mentioned. Pwaves may be present in
> > PVCs or PACS. One has to be careful to determine whether the Pwave is
> > 'associated' with the QRS complex.
> >
> > Some rythms can be tricky to differentiate in a 12 lead. If it is bigeminy
> > with a bundle branch block, for example, it can be nearly impossible to
> > determine from a single 12lead which is the ectopy and which is the
> > underlying rhythm.
> >
> > Cheers,
> > Nick
> >
> > On Sun, Jul 5, 2009 at 11:12, jesse12848 <jesse12848@> wrote:
> >
> > >
> > >
> > > --- In ekg_club@yahoogroups.com <ekg_club%40yahoogroups.com>,
> > > "thatsuthant" <thatsuthant@> wrote:
> > > >
> > > > Hi every one,
> > > > How do you differentiate atrial ectopic beats from ventricular ectopic
> > > beats?. Any one can define me please?.
> > > > Ventricular ectopic beats are clearly seen on ECG . But atrial ectopic
> > > beats, how you all find those?. Please give some of your thoughts.
> > > >
> > > > Thanks
> > > >
> > > >
> > > >
> > > > --- In ekg_club@yahoogroups.com <ekg_club%40yahoogroups.com>, Klaus
> > > Skrudland <lapsklaus@> wrote:
> > > > >
> > > > > Hi all. Just want to present to you a case of what I believe is a quite
> > > > > uncommon ectopic rhythm.
> > > > >
> > > > > The patient is a 55 y/o male with a well known paroxysmal atrial
> > > > > fibrillation. He uses flecainide and metoprolol and was admitted for
> > > onset
> > > > > of what he thought was atrial fibrillation.
> > > > >
> > > > > As you will see from the ecg, the ventricular rate is irregular. Right
> > > > > precordial leads show ectopic, positive P waves. PP intervals are
> > > regular
> > > > > with a rate of 230 bpm. When marching them out with a caliper (see the
> > > dots
> > > > > I made), they seem to march right through the QRS complexes and don´t
> > > seem
> > > > > to get conducted. However, there can´t be AV dissociation, as there is
> > > no
> > > > > evidence of an escape pacemaker present (and the ventricular rate is
> > > > > irregular).
> > > > >
> > > > > As a matter of fact, the P waves does seem to get conducted after all.
> > > My
> > > > > colleague Terje (the other Norwegian here in the club) pointed out that
> > > the
> > > > > PR interval in fact gets progressively longer. And at this point, I´m
> > > > > struggling to understand the rest of the mechanism. Most likely, this
> > > atrial
> > > > > tachycardia with some kind of Wenkebach conduction.
> > > > >
> > > > > Comments? Thoughts? Ideas? Anyone wanna make a ladderdiagram to explain
> > > the
> > > > > mechanism?! ;-)
> > > > >
> > > > > klaus
> > > > >
> > > >
> > > In the caes of a true atrial ectopic beat, the QRS will be preceded by a
> > > definite, upright P wave. P wave morphology may fulctuate (wandering
> > > pacemaker, etc.), but if the premature beat is truely atrial in origin then
> > > a P wave will be present. Another way to distinguish PACs from PVCs is to
> > > view them in leads I and III. Also remember that PACs have a QRS duration
> > > time of < 0.12 sec, whereas PVCs almost always have duration times > 0.12
> > > sec.
> > > If your sure that it's a PVC your looking at, you can determine L or R
> > > origin by viewing it in MCL1/v1. L vent PVCs will be positive in deflection
> > > while R vent PVCs will be aberrant. Hope this helps.
> > >
> > >
> > >
> >
> Nick, right on. Thats a great catch. It is important to determine wether the P wave is in fact associated with the QRS. Thanks for the correction.
>

I'm just a lowly paramedic :-), and I just looked at Klaus attached file of the rhythm in question. V1 appears to display a 2nd degree type II AV blockade. Am I wrong in my interpretation or am I looking at the wrong rhythm? Sorry if I sound a little confused.