Junctional rhythm, anterior and inferior wall infarction

Junctional rhythm, inferior and anterior wall infarction

QS complexes in inferior and anterior leads indicate old anterior and inferior wall infarction. It is a slow rhythm with no P waves preceding the QRS complexes, a feature of junctional rhythm. Notch at the proximal region of the ST segment is suggestive of retrograde P waves. Generalised flattening of T waves can occur due to hypokalemia or hypothyroidism. Absence of significant ST – T changes make digoxin less likely as the causative agent for the brady rhythm. Limbs somewhat meet the criteria for low voltage of less than 5 mm amplitude in limb leads, while the chest leads do not meet the criteria of less than 10 mm amplitude in all chest leads.