{"id":23859,"date":"2018-04-20T05:52:17","date_gmt":"2018-04-20T00:22:17","guid":{"rendered":"https:\/\/cardiophile.org\/?p=23859"},"modified":"2024-02-04T12:57:02","modified_gmt":"2024-02-04T07:27:02","slug":"ecg-quiz-answer-first-degree-av-block-sinus-pause-qt-prolongation","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/ecg-quiz-answer-first-degree-av-block-sinus-pause-qt-prolongation\/","title":{"rendered":"ECG Quiz Answer &#8211; First degree AV block, sinus pause, QT prolongation"},"content":{"rendered":"<h2><span style=\"color: #008000;\">ECG Quiz Answer &#8211; First degree AV block, sinus pause, QT prolongation<img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-33341\" src=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2018\/04\/First-degree-AV-block-and-sinus-pause-2.jpg\" alt=\"First degree AV block and sinus pause\" width=\"2495\" height=\"676\" \/><\/span><\/h2>\n<p align=\"LEFT\">PR interval is prolonged and measures 240 ms. A sinus pause of 1880 ms is seen at the end of the tracing. Together these indicate dual nodal dysfunction. <em>An interesting finding is the recovery of AV conduction after the long pause so that PR interval in the beat following the pause is only 120 ms.<\/em><\/p>\n<p align=\"LEFT\">QT interval is 440 ms with a cycle length of 640 ms, indicating a QTc of around 550 ms. It may be noted that the QT prolongation is predominantly due to prolongation of ST segment. ST prolongation contributing to QT prolongation is characteristic of hypocalcemia. This is because calcium is the ion predominantly involved in the phase 2 (plateau phase) of the myocardial action potential.<\/p>\n<p align=\"LEFT\">A case of hypocalcemia induced ST prolongation causing QT prolongation has been reported by Gardner JD and colleagues [1]. In that case, serum calcium was 5.0 mg\/dL and QT interval 440 ms with correct QT interval (QTc) 533 ms. In another case reported in the same article, with serum calcium of 12 mg\/dL, there was no discernible ST segment.\u00a0QT interval was 320 ms and QTc was 341 ms.\u00a0The patient had primary hyperparathyroidism due to parathyroid adenoma and hypercalcemia reverted after surgical removal of the adenoma.<\/p>\n<div>\n<div class=\"x_gmail_signature\"><a href=\"\/professional\/ecg-quiz-21\/\"><strong>Back to question<\/strong><\/a><\/div>\n<\/div>\n<div><\/div>\n<div><span style=\"color: #0000ff;\"><strong>Reference<\/strong><\/span><\/div>\n<div><\/div>\n<ol>\n<li>Gardner JD, Calkins JB Jr, Garrison GE. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3951043\/\">ECG diagnosis: The effect of ionized serum calcium levels on electrocardiogram<\/a>. Perm J. 2014 Winter;18(1):e119-20.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>First degree AV block, sinus pause, QT prolongation &#8211; ECG Quiz Answer. PR interval is prolonged and measures 240 ms. A sinus pause of 1880 ms is seen at the end of the tracing. Together these indicate dual nodal (atrioventricular and sinoatrial node) dysfunction. <\/p>\n","protected":false},"author":1,"featured_media":33341,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[6,7],"tags":[1757,3666],"class_list":["post-23859","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ecg-electrophysiology","category-ecg-library","tag-hypocalcemia","tag-st-prolongation"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>First degree AV block and sinus pause - ECG Quiz Answer<\/title>\n<meta name=\"description\" content=\"First degree AV block and sinus pause - ECG Quiz Answer. PR interval is prolonged, sinus pause of 1880 ms is seen at end of the tracing.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/ecg-quiz-answer-first-degree-av-block-sinus-pause-qt-prolongation\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"First degree AV block and sinus pause - ECG Quiz Answer\" \/>\n<meta property=\"og:description\" content=\"First degree AV block and sinus pause - ECG Quiz Answer. PR interval is prolonged, sinus pause of 1880 ms is seen at end of the tracing.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/johnsonfrancis.org\/professional\/ecg-quiz-answer-first-degree-av-block-sinus-pause-qt-prolongation\/\" \/>\n<meta property=\"og:site_name\" content=\"All About Cardiovascular System and Disorders\" \/>\n<meta property=\"article:published_time\" content=\"2018-04-20T00:22:17+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2024-02-04T07:27:02+00:00\" \/>\n<meta name=\"author\" content=\"Johnson Francis\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Johnson Francis\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/ecg-quiz-answer-first-degree-av-block-sinus-pause-qt-prolongation\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/ecg-quiz-answer-first-degree-av-block-sinus-pause-qt-prolongation\\\/\"},\"author\":{\"name\":\"Johnson Francis\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"headline\":\"ECG Quiz Answer &#8211; First degree AV block, sinus pause, QT prolongation\",\"datePublished\":\"2018-04-20T00:22:17+00:00\",\"dateModified\":\"2024-02-04T07:27:02+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/ecg-quiz-answer-first-degree-av-block-sinus-pause-qt-prolongation\\\/\"},\"wordCount\":246,\"publisher\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"image\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/ecg-quiz-answer-first-degree-av-block-sinus-pause-qt-prolongation\\\/#primaryimage\"},\"thumbnailUrl\":\"\",\"keywords\":[\"Hypocalcemia\",\"ST prolongation\"],\"articleSection\":[\"ECG \\\/ Electrophysiology\",\"ECG Library\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/ecg-quiz-answer-first-degree-av-block-sinus-pause-qt-prolongation\\\/\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/ecg-quiz-answer-first-degree-av-block-sinus-pause-qt-prolongation\\\/\",\"name\":\"First degree AV block and sinus pause - ECG Quiz Answer\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/ecg-quiz-answer-first-degree-av-block-sinus-pause-qt-prolongation\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/ecg-quiz-answer-first-degree-av-block-sinus-pause-qt-prolongation\\\/#primaryimage\"},\"thumbnailUrl\":\"\",\"datePublished\":\"2018-04-20T00:22:17+00:00\",\"dateModified\":\"2024-02-04T07:27:02+00:00\",\"description\":\"First degree AV block and sinus pause - ECG Quiz Answer. 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