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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Collapsed After A Swim. ECG Shows SR Abnormal P Wave, Conduction Pathways. Explain

Hi. I'm a cardiac assessment nurse and have just reviwed a 17 yr female. She is a swimmer and competes at national level. She had a collapse this evening and fell down the stairs. GCS 3 initially but spontaneously recovered to 15 o/a to A/E roughly 20mins. She has been admitted to CCU for monitoring
Her ECG shows SR but has anormal P wave then a retrograde P wave and this is the pattern throughout her ECG. Her ST segments appear a little unusual and have a slight arch shape. Ithink she has 2 conduction pathways but I would be interested to find some similar ECGs if you can help me with identifying the rhythm.
Thank you
Helen
Wed, 22 May 2013
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Critical Care Specialist 's  Response
Hi Helen
Thanks for posting your query
Identification of rhythm by description is extremely difficult some time it difficult even in 12 lead ECG to identify rhythm correctly and we require Elecrophysiological (EP) study.
By clinical background it seems that patient is having advanced conduction block or slow junctional rhythm. ST segments changes are secondary to conduction abnormality not because of ischemia.
I tried to answer your query but for detail discussion we would like to see 12 Lead ECG
Thanks Take care
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Collapsed After A Swim. ECG Shows SR Abnormal P Wave, Conduction Pathways. Explain

Hi Helen Thanks for posting your query Identification of rhythm by description is extremely difficult some time it difficult even in 12 lead ECG to identify rhythm correctly and we require Elecrophysiological (EP) study. By clinical background it seems that patient is having advanced conduction block or slow junctional rhythm. ST segments changes are secondary to conduction abnormality not because of ischemia. I tried to answer your query but for detail discussion we would like to see 12 Lead ECG Thanks Take care