Answer DV Case 4: Difference between revisions
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{{Case| | {{Case| | ||
|previouspage= | |previouspage= DV_Case_3 | ||
|previousname= | |previousname= DVA Case 3 | ||
|nextpage= | |nextpage= DV_Case_5 | ||
|nextname= | |nextname= DVA Case 5 | ||
}} | }} | ||
[[Image:DVA0004.jpg|700px|thumb|left|DV Case 4. Click on image for enlargement.]] | [[Image:DVA0004.jpg|700px|thumb|left|DV Case 4. Click on image for enlargement.]] | ||
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#what is your next step in your workup? | #what is your next step in your workup? | ||
==Answers== | ==Answers== | ||
# The rhythm shows inverted P-waves in the inferior leads indicative of atrial rhythm. | # The rhythm shows inverted P-waves in the inferior leads indicative of [[Atrial_Rhythm|atrial rhythm]]. | ||
# The answer on this question is difficult. An atrial rhythm can be the result of SA block. This ECG however cannot produce the proper answer. The use of beta-blockers for instance, could cause a marked lowering of the sinus rhythm, allowing for an atrial escape rhythm, which is slow as well. | # The answer on this question is difficult. An atrial rhythm can be the result of SA block. This ECG however cannot produce the proper answer. The use of beta-blockers for instance, could cause a marked lowering of the sinus rhythm, allowing for an atrial escape rhythm, which is slow as well. | ||
# The cause of the pauses in the atrial rhythm are atrial premature beats, blocking the exit of the atrial prevailing atrial rhythms. These atrial premature beats | # The cause of the pauses in the atrial rhythm are atrial premature beats, blocking the exit of the atrial prevailing atrial rhythms. These [[Atrial_Premature_Complexes|atrial premature beats]] can be appreciated when looking at the T-waves of the conducted beats preceding the pause. | ||
# This question cannot be answered on this ECG. Pacing could be indicated as the patient has dizzy spells. However, blocked atrial beats per se are no pacemaker indication. | # This question cannot be answered on this ECG. Pacing could be indicated as the patient has dizzy spells. However, blocked atrial beats per se are no pacemaker indication. | ||
# The proper workup could be: | # The proper workup could be: | ||
##stopping medication that lowers the sinus node frequency (B-blockers, funny current blockers, calcium channel blockers) | |||
##a long term ECG recording. | |||
##measuring the sinus node recovery time is questionable. | |||