{"id":29060,"date":"2019-03-15T03:15:20","date_gmt":"2019-03-15T03:15:20","guid":{"rendered":"https:\/\/johnsonfrancis.org\/professional\/?p=29060"},"modified":"2024-02-02T06:42:42","modified_gmt":"2024-02-02T01:12:42","slug":"ecg-quiz-49-discussion","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/ecg-quiz-49-discussion\/","title":{"rendered":"Inferior Wall Infarction with 2:1 AV Block"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/Ij5FiJcSu4c?si=0wCkvQtllObMdFDw\" title=\"YouTube video player\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" allowfullscreen><\/iframe><\/p>\n<h2><span style=\"color: #008000;\">ECG Quiz 49 &#8211; Discussion<\/span><\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-29061\" src=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2019\/03\/Hyperacute-IWMI-2-1-AV-Block.jpg\" alt=\"\" width=\"1914\" height=\"925\" \/><\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2019\/03\/Hyperacute-IWMI-2-1-AV-Block.jpg\">Click here for a larger image<\/a><\/p>\n<p>PP interval is half that of the RR interval. The P wave marked by <span style=\"color: #ff0000;\">red arrow<\/span> is non conducted, while the P wave marked by the <span style=\"color: #0000ff;\">blue arrow<\/span> is followed by a QRS complex. So it is a 2:1 AV conduction, also known as 2:1 second degree AV block. It is possible that longer recordings might show slight changes in P-QRS relationship so that it could even be complete AV block appearing as 2:1 AV block for a short period of time during the ECG recording. As the QRS complex is narrow, it is likely to be supra Hisian block at the AV nodal level rather than an infra Hisian block. Moreover, ECG shows features of inferior wall myocardial infarction, which is associated with AV nodal block and not infra Hisian block.<\/p>\n<p>Inferior wall infarction is evidenced by the prominent upsloping ST elevation (<span style=\"color: #0000ff;\">Pardee&#8217;s sign<\/span>) in the inferior leads (II, III and aVF) with upright T waves. ST elevation is significantly more in lead III than in lead II, suggesting that it is due to an occlusion of the right coronary artery rather than the left circumflex coronary artery. ST depression is seen in the anterior and lateral leads which could be either a <span style=\"color: #0000ff;\">reciprocal change<\/span> or <span style=\"color: #0000ff;\">ischemia at a distance<\/span>. Final proof will come from the coronary angio prior to primary angioplasty, which will be the therapeutic option of choice in this case. A temporary pacing wire will also be needed as there is a chance of development of complete heart block and symptomatic bradycardia.<\/p>\n<p><a href=\"https:\/\/johnsonfrancis.org\/professional\/ecg-quiz-49\/\"><strong>Back to ECG Quiz 49<\/strong><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>ECG Quiz 49 &#8211; Discussion Click here for a larger image PP interval is half that of the RR interval. The P wave marked by red arrow is non conducted, while the P wave marked by the blue arrow is followed by a QRS complex. So it is a 2:1 AV conduction, also known as [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":29061,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[6,7],"tags":[2789],"class_list":["post-29060","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ecg-electrophysiology","category-ecg-library","tag-pardees-sign"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Inferior Wall Infarction with 2:1 AV Block - All About Cardiovascular System and Disorders<\/title>\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-49-discussion\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Inferior Wall Infarction with 2:1 AV Block - All About Cardiovascular System and Disorders\" \/>\n<meta property=\"og:description\" content=\"ECG Quiz 49 &#8211; Discussion Click here for a larger image PP interval is half that of the RR interval. The P wave marked by red arrow is non conducted, while the P wave marked by the blue arrow is followed by a QRS complex. So it is a 2:1 AV conduction, also known as [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/johnsonfrancis.org\/professional\/ecg-quiz-49-discussion\/\" \/>\n<meta property=\"og:site_name\" content=\"All About Cardiovascular System and Disorders\" \/>\n<meta property=\"article:published_time\" content=\"2019-03-15T03:15:20+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2024-02-02T01:12:42+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\\\/ecg-quiz-49-discussion\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/ecg-quiz-49-discussion\\\/\"},\"author\":{\"name\":\"Johnson Francis\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"headline\":\"Inferior Wall Infarction with 2:1 AV Block\",\"datePublished\":\"2019-03-15T03:15:20+00:00\",\"dateModified\":\"2024-02-02T01:12:42+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/ecg-quiz-49-discussion\\\/\"},\"wordCount\":274,\"publisher\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"image\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/ecg-quiz-49-discussion\\\/#primaryimage\"},\"thumbnailUrl\":\"\",\"keywords\":[\"Pardee's sign\"],\"articleSection\":[\"ECG \\\/ Electrophysiology\",\"ECG Library\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/ecg-quiz-49-discussion\\\/\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/ecg-quiz-49-discussion\\\/\",\"name\":\"Inferior Wall Infarction with 2:1 AV Block - 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