{"id":29133,"date":"2019-03-24T00:28:04","date_gmt":"2019-03-24T00:28:04","guid":{"rendered":"https:\/\/johnsonfrancis.org\/professional\/?p=29133"},"modified":"2024-02-05T19:44:41","modified_gmt":"2024-02-05T14:14:41","slug":"ecg-quiz-51-discussion","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/ecg-quiz-51-discussion\/","title":{"rendered":"ECG Quiz 51 &#8211; Discussion"},"content":{"rendered":"<h2><span style=\"color: #008000;\">ECG Quiz 51 &#8211; Discussion<\/span><\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-29137\" src=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2019\/03\/ecg51a.jpg\" alt=\"\" width=\"1891\" height=\"715\" \/><\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2019\/03\/ecg51a.jpg\"><strong>Click here for a larger image<\/strong><\/a><\/p>\n<p>This ECG shows a narrow QRS tachycardia at a rate of around 180\/min. No P waves are seen to precede the QRS complexes. Then it has to be taken as supraventricular tachycardia.<\/p>\n<p>Close scrutiny of the tracing shows probable negative P waves after the QRS complex in lead II (<span style=\"color: #ff0000;\">red arrow<\/span>). They are called &#8216;<span style=\"color: #0000ff;\">pseudo s<\/span>&#8216; waves produced by retrograde P waves. This pattern is seen in atrioventricular nodal reentrant tachycardia (AVNRT). Here the RP is shorter than PR (from retrograde P to next R wave), qualifying for the <span style=\"color: #0000ff;\">short RP tachycardia<\/span> of the <span style=\"color: #0000ff;\">slow-fast variety of AVNRT<\/span>.<\/p>\n<p>In the slow-fast variety, an atrial ectopic beat is conducted down the slow pathway as it finds the fast pathway refractory after the previous sinus beat. It may be noted that the slow pathway recovers fast while fast pathway recovers next.<\/p>\n<figure id=\"attachment_47877\" aria-describedby=\"caption-attachment-47877\" style=\"width: 1095px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-47877\" src=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2019\/03\/Dual-AV-nodal-physiology.jpg\" alt=\"Dual AV nodal physiology\" width=\"1095\" height=\"600\" \/><figcaption id=\"caption-attachment-47877\" class=\"wp-caption-text\">Dual AV nodal physiology<\/figcaption><\/figure>\n<p>This feature is seen in those with <span style=\"color: #0000ff;\">dual AV nodal physiology<\/span>. The sudden increase in PR interval after an atrial ectopic beat (an atrial extra stimulus during an electrophysiology study) is known as &#8216;<span style=\"color: #0000ff;\">PR jump<\/span>&#8216;. PR jump has to be more than 50 ms to be significant. This tachycardia can be called as a short RP tachycardia as RP is shorter than PR.<\/p>\n<figure id=\"attachment_47883\" aria-describedby=\"caption-attachment-47883\" style=\"width: 1052px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-47883\" src=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2019\/03\/PR-Jump-and-Echo-Beat2.jpg\" alt=\"PR Jump and Echo Beat\" width=\"1052\" height=\"622\" \/><figcaption id=\"caption-attachment-47883\" class=\"wp-caption-text\">PR Jump and Echo Beat<\/figcaption><\/figure>\n<p>The R waves in V1 (<span style=\"color: #008000;\">green arrow<\/span>) are a bit too tall to be called as the corresponding &#8216;pseudo r&#8217;, but the r waves in aVR are of the size usually seen with pseudo r (<span style=\"color: #000000;\">black arrow<\/span>). The taller R wave in V1 could be because there is an element of incomplete right bundle branch due to the fast rate (<span style=\"color: #0000ff;\">phasic aberrant conduction<\/span>).<\/p>\n<p><a href=\"https:\/\/johnsonfrancis.org\/professional\/ecg-quiz-51\/\"><strong>Back to ECG Quiz 51<\/strong><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>ECG Quiz 51 &#8211; Discussion Click here for a larger image This ECG shows a narrow QRS tachycardia at a rate of around 180\/min. No P waves are seen to precede the QRS complexes. Then it has to be taken as supraventricular tachycardia. Close scrutiny of the tracing shows probable negative P waves after the [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":29137,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[6,7],"tags":[],"class_list":["post-29133","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ecg-electrophysiology","category-ecg-library"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ECG Quiz 51 - Discussion - 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-51-discussion\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ECG Quiz 51 - Discussion - All About Cardiovascular System and Disorders\" \/>\n<meta property=\"og:description\" content=\"ECG Quiz 51 &#8211; Discussion Click here for a larger image This ECG shows a narrow QRS tachycardia at a rate of around 180\/min. No P waves are seen to precede the QRS complexes. Then it has to be taken as supraventricular tachycardia. Close scrutiny of the tracing shows probable negative P waves after the [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/johnsonfrancis.org\/professional\/ecg-quiz-51-discussion\/\" \/>\n<meta property=\"og:site_name\" content=\"All About Cardiovascular System and Disorders\" \/>\n<meta property=\"article:published_time\" content=\"2019-03-24T00:28:04+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2024-02-05T14:14:41+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-51-discussion\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/ecg-quiz-51-discussion\\\/\"},\"author\":{\"name\":\"Johnson Francis\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"headline\":\"ECG Quiz 51 &#8211; 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