The ECG reveals an irregular bradycardic arrhythmia, characterized by conduction abnormalities at the level of both SA node, as evidenced by the absence of some P waves, and the AV node, where the P waves fail to conduct to the ventricles to produce QRS complexes.
The coexistence of mixed conduction abnormalities in the context of end-stage renal disease (ESRD) raises suspicion for electrolyte imbalances as the primary etiology. This hypothesis was substantiated by laboratory findings indicating elevated levels of potassium (6.7 mg/dL) and decreased levels of calcium (7.1 mg/dL).
The coexistence of mixed conduction abnormalities in the context of end-stage renal disease (ESRD) raises suspicion for electrolyte imbalances as the primary etiology. This hypothesis was substantiated by laboratory findings indicating elevated levels of potassium (6.7 mg/dL) and decreased levels of calcium (7.1 mg/dL).
What kind of block is observed in the ECG?
Anonymous Poll
16%
SA node block
26%
Type 1 AVB
25%
Second degree AV block: Mobitz type 1
24%
Second degree AV block: Mobitz type 2
10%
Complete heart block
The ECG demonstrates grouped beats. P-waves precede the QRS complexes with constant but prolonged PR intervals. This indicates a first-degree AV block.
Please note that P-wave is absent during the pause between the grouped beats. This pattern suggests an SA node block, rather than a second-degree AV block, in which a P-wave is present during the pause but is not followed by a QRS complex.
For more advanced users:
The P-P interval progressively shortens prior to the dropped P wave. The duration of the PP interval during the pause is less than twice the length of the shortest PP interval which is observed prior to the pause. This suggests a second-degree, Wenckebach sinoatrial block.
Special thanks to Dr. Salvatore for his expert ECG interpretation and the informative diagram he provided.
Please note that P-wave is absent during the pause between the grouped beats. This pattern suggests an SA node block, rather than a second-degree AV block, in which a P-wave is present during the pause but is not followed by a QRS complex.
For more advanced users:
The P-P interval progressively shortens prior to the dropped P wave. The duration of the PP interval during the pause is less than twice the length of the shortest PP interval which is observed prior to the pause. This suggests a second-degree, Wenckebach sinoatrial block.
Special thanks to Dr. Salvatore for his expert ECG interpretation and the informative diagram he provided.
Based on the provided ECG findings, what is the most likely diagnosis?
Anonymous Poll
12%
Ventricular tachycardia
34%
Atrial fibrillation with LBBB and Ashman phenomena
20%
AVNRT with LBBB and PVCs
34%
Junctional tachycardia with LBBB and PVCs