Changes

<div style="padding:5px;background:white;border:1px solid #ccc;">

<div style="padding:5px;background:white;border:1px solid #ccc;">

<div align="center" style="margin-top:15px;">

<div align="center" style="margin-top:15px;">

[[File:E0003197.png|200px|thumb|center]]

[[File:CaseFeb2016.png|300px]]</div>

[[File:E0003198.png|200px|thumb|center]]

{{clr}}

{{clr}}

''Courtesy of W.K. Lagrand and P.G. Postema, The Netherlands''<br />

[[ Answer - Case of the month (Feb 2016) | Click here for the correct answer ]]

A 53 year old woman has had mitral and tricuspid valve repair. An ECG is recorded. No P waves are seen before QRS complexes. She has temporary atrial pacemaker leads and a recording is made from these leads (recorded as V1 in the second ECG). Now it is evident that a junctional rhythm is present with retrograde P waves. A very long PQ interval is a differential diagnosis, but less likely.

</div>

</div>

</div>

</div>