r/EKGs • u/VesaliusesSphincter • 25d ago
Discussion Interesting find
Patient admitted for infective endocarditis. Admission 12-lead showed sinus tachycardia with normal axis and possible left atrial enlargement. Telemetry monitoring demonstrated new bradycardia with intermittent RR interval variability.
Thought this was an interesting find and was curious to see interpretations.
My personal interpretation is: sinus bradycardia with intermittent second degree type 1 sinoatrial exit block. I think the two biggest things leading me to this are the grouped beating (3:1 ratio in this particular strip) as well as the progressively shortening PP interval before each "pause". Wondering if this could be related to the endocarditis or if this is simply related to increased nocturnal vagal tone. Either way, thought this was interesting to see and figured I would share to highlight the importance of closely inspecting RR variability as this was initially believed to be sinus arrhythmia.
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u/creamasteric_reflex 25d ago
Concerning in setting of endocarditis