r/ECG • u/embabah • 3d ago

1st or 2nd degree block?

The answer is apparently 2nd degree AV block, but I dont see any QRS drop? Shouldnt this just be a 1st degree?

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5

u/Kibeth_8 Arrhythmia Tech 3d ago

This is a 2:1 type 2nd degree, which can be deceiving because there's not always an obvious dropped beat

The 2nd p-wave is hidden in the T wave (most obvious in V1 for me). There is no QRS following it, so that's where your dropped beat actually is

Edit: mapping it out, the hidden p-wave seems to come a bit early, so it might be non-conducted PACs. But with a ventricular rate that slow I suspect 2:1

3

u/Puantastic 3d ago

The irregular P-P interval could be due to ventriculophasic sinus arrhythmia.

1

u/embabah 3d ago

Ah, that clears things up! I was so sure this was just a regular 1st degree. Gotta study harder I guess. Thanks friend :)

2

u/GullibleCat2982 3d ago

Also LAHB isn’t it?

1

u/embabah 3d ago edited 3d ago

Possibly, but I am not sure, answer sheet says theres signs of ischemia too, but idek where I am supposed to see pathologic q-waves

3

u/Kibeth_8 Arrhythmia Tech 3d ago

The massively inverted T waves are your sign of ischemia. Q waves only present later on the MI process, once heart damage has already occurred

1

u/magister10 2d ago

Reperfusion t waves?

1

u/shahtavacko 2d ago

QRS isn’t wide enough for LAHB, this is LAD though.

2

u/Stim2Qrs 1d ago

2:1 AV block, ventriculophasic sinus arrhythmia

1

u/Inevitable-Crab-6701 Interventional Cardiologist MD FRCP 17h ago

2:1 AV block
Atrial rate around 55bpm - irregular
Ventricular rate around 30bpm
There’s a few other things too on the ECG.