{"id":27230,"date":"2018-11-13T10:22:49","date_gmt":"2018-11-13T10:22:49","guid":{"rendered":"https:\/\/johnsonfrancis.org\/professional\/?p=27230"},"modified":"2018-11-13T10:22:49","modified_gmt":"2018-11-13T10:22:49","slug":"arrhythmia-quiz-1-discussion","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/arrhythmia-quiz-1-discussion\/","title":{"rendered":"Arrhythmia Quiz 1 &#8211; Discussion"},"content":{"rendered":"<h2><span style=\"color: #008000;\">Arrhythmia Quiz 1 &#8211; Discussion<\/span><\/h2>\n<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/tOwf9aKubQI\" title=\"YouTube video player\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen=\"\"><\/iframe><\/p>\n<figure id=\"attachment_27232\" aria-describedby=\"caption-attachment-27232\" style=\"width: 936px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-27232 size-full\" src=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2018\/11\/A1.gif\" alt=\"Arrhythmia Quiz 1 - Discussion\" width=\"936\" height=\"417\"><figcaption id=\"caption-attachment-27232\" class=\"wp-caption-text\"><em><strong><span style=\"color: #0000ff;\">Arrhythmia Quiz 1 &#8211; Discussion:&nbsp;Escape-echo bigeminy<\/span><\/strong><\/em><\/figcaption><\/figure>\n<p>The beats marked as <strong><span style=\"color: #ff0000;\">J<\/span><\/strong> are junctional escape beats, occurring at a slow rate. They are followed by inverted P waves in inferior leads prior to the next QRS complex (marked by blue up arrows). These beats could be either beats originating from the low atrium (coronary sinus rhythm) or from the high junction.<\/p>\n<p>Inverted P waves preceding QRS complexes can be seen in high junctional rhythm as the conduction into the atria are from below upwards, away from the positive electrodes of inferior leads. In low junctional rhythm, inverted P waves occur after the QRS complex as the ventricular activation occurs before the atrial activation. In mid junctional rhythm, P waves are not visible as there is simultaneous activation of the ventricles and the atria and P waves are obscured by the QRS complexes. Beats marked as <strong><span style=\"color: #ff0000;\">J&nbsp;<\/span><\/strong>can be considered as mid junctional. The bigeminal rhythm is suggestive of an&nbsp;<em>escape capture bigeminy<\/em>. But typically, the second beat in an escape capture bigeminy is a sinus beat. It appears that here escape capture bigeminy occurs in the setting of a low atrial rhythm. Overall features suggest sick sinus syndrome.<\/p>\n<p>Thanks to my Twitter colleague <a class=\"fullname ProfileNameTruncated-link u-textInheritColor js-nav\" href=\"https:\/\/twitter.com\/SergioPinski\" data-aria-label-part=\"\" data-send-impression-cookie=\"true\">Sergio Pinski<\/a><b class=\"u-linkComplex-target\"><\/b>&nbsp;for enlightening me on the possibility of <span style=\"color: #0000ff;\"><em>Escape-echo bigeminy<\/em><\/span>&nbsp;in this case [1].<\/p>\n<p><a href=\"https:\/\/johnsonfrancis.org\/professional\/arrhythmia-quiz-1\/\"><strong>Back to quiz<\/strong><\/a><\/p>\n<h2><span style=\"color: #0000ff;\">Reference<\/span><\/h2>\n<ol>\n<li>Barold SS, Stroobandt R, Herweg B. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22225653\">Escape-echo bigeminy.<\/a> Electrocardiol. 2012 Mar;45(2):167-9.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Arrhythmia Quiz 1 &#8211; Discussion The beats marked as J are junctional escape beats, occurring at a slow rate. They are followed by inverted P waves in inferior leads prior to the next QRS complex (marked by blue up arrows). These beats could be either beats originating from the low atrium (coronary sinus rhythm) or [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":27232,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[6,7],"tags":[1400,1401],"class_list":["post-27230","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ecg-electrophysiology","category-ecg-library","tag-escape-capture-bigeminy","tag-escape-echo-bigeminy"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Arrhythmia Quiz 1 - Discussion:\u00a0Escape-echo bigeminy<\/title>\n<meta name=\"description\" content=\"Arrhythmia Quiz 1 - Discussion:\u00a0Escape-echo bigeminy: Mid junctional escape beats followed by echo beats with inverted P waves preceding the QRS complex.\" \/>\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\/arrhythmia-quiz-1-discussion\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Arrhythmia Quiz 1 - Discussion:\u00a0Escape-echo bigeminy\" \/>\n<meta property=\"og:description\" content=\"Arrhythmia Quiz 1 - Discussion:\u00a0Escape-echo bigeminy: Mid junctional escape beats followed by echo beats with inverted P waves preceding the QRS complex.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/johnsonfrancis.org\/professional\/arrhythmia-quiz-1-discussion\/\" \/>\n<meta property=\"og:site_name\" content=\"All About Cardiovascular System and Disorders\" \/>\n<meta property=\"article:published_time\" content=\"2018-11-13T10:22:49+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=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/arrhythmia-quiz-1-discussion\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/arrhythmia-quiz-1-discussion\\\/\"},\"author\":{\"name\":\"Johnson Francis\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"headline\":\"Arrhythmia Quiz 1 &#8211; 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