Talk:Puzzle 2008 04 014 Answer

the discussant states that the second ECG (1b i think) is a ventricular rhythm, but then goes on to state that the second ECG shows bifascicular block (LAFB+RBBB). the latter diagnosis can not be made in a ventricular rhythm since the his pukinje system is in no way involved with producing an ectopic ventricular (escape) rhythm and hence cannot be detected in a ventricular rhythm. either he/she is wrong about the second ecg being a ventricular escape rhythm or he/she is wrong about the diagnoses of acquired LAFB and RBBB. I suspect the former is the case and the second ECG is in fact a JUNCTIONAL escape rhythm, widened by ischeamic bifasicular block