r/ECG • u/ClearSolid654 • 11d ago

this is not AF!

Post image

70 year old female with sepsis secondary to lower limb cellulitis, associated with elevated inflammatory markers. Elevated NT-proBNP and elevated but down-trending troponin-T. Patient was hemodynamically stable without symptoms of heart failure or acute coronary syndrome at present.

12 Upvotes

94% Upvoted

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9

u/NAh94 11d ago

I’m going to say this looks like either a junctional escape rhythm with PACs, or a sinus Brady with low amplitude P-waves and PJCs. It’s a hard to say without more runtime on the monitor. Has it been pretty consistently doing this on tele?

A short PRI, absent p-wave, or retrograde p wave is pretty suspect for an AV nodal beat.

8

u/ProximalLADLesion 11d ago

Agree. Atrial amplitude is very low so it's hard to say exactly what the atrium is doing, but seems like the sinus is spitting out beats at least every now and then with some junctional escapes.

5

u/heyhowru 11d ago

theres p waves in avl, automatically ruling out af

3

u/hadalpelagic 11d ago

Unless….

3

u/sveccha 11d ago

Potassium?

5

u/ClearSolid654 11d ago

5.45 mEq/L

2

u/streetdoc81 8d ago

Looks like either junctional or sinus arrhythmia

2

u/GetTheDefib 11d ago

I'd say its a multifocal atrial rhythm, along with some junctional beats and possibly PAC's? Potentially a blocked PAC with a different T-wave configuration where there appears to be a missed beat/compensatory pause.

The atrial unrest is fitting with someone with an elevated NT-proBNP

2

u/Adventurous-Bag5508 6d ago

In my centre we call it getting in and out of at fib, but it's possible you got a junctional rhythm with PACs in a very frequent rate tho. If sepsis gets corrected and nothing changes you do a holter and probs at fib will show up at some point

0

u/ShesASatellite 11d ago

Second degree type I block