Your Rhythm for October 2010
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I would like to encourage you to leave me a comment. If you have a rhythm I can possibly help you with, please contact me.
These two rhythm strips have the same name, but…there is a significant difference. The QRS complexes in strip A are narrow which tells us the ventricles are being controlled somewhere above the ventricles; probably the AV Node since there are no P waves associated with the QRS complexes with a ventricular rate in the 50s. On the other hand, the QRS complexes in strip B are wide, telling us the ventricles are controlling themselves ; the ventricular rate is in the 30's reinforcing that thought. You will notice the atrial rhythm (although you can’t actually visualize all the P waves because they are hidden in some places) is regular and at a sinus node rate of 60 to 100 bpm. The ventricular rhythm is also regular and very slow. If you try to measure (with calipers of course) the P to P interval and then try to match it up with the QRS to QRS interval, you will find they don’t match. That is because the atrial rhythm and the ventricular rhythm are beating independently of each other and at different rates. The P waves are not conducting to the ventricles. If you tried to measure the PRI’s, which is not done in CHB, you would find most, if not all PRI's, are all different from each other. So, have you figured out the name of this rhythm?
This is Complete Heart Block (CHB) or Third degree Heart Block. And my next question to you would be: If you had to be in CHB, which rhythm strip A or B, would you rather have and why? I will post on EKGs 4U Facebook page the one I would rather have and why.
I hope you have found this helpful and I look forward to your return next month. Thanks for stopping by.
Beth