A 32 year old Male, professional athlete, came with this ECG Try to spot the findings in this ECG and make a diagnosis. (Answer will be explained after 30 seconds)
Answer Explanation: It’s a 12 lead surface ECG with a standard calibration and paper speed of 25mm/second. There is a p wave followed by a narrow QRS complex, then there is a broad QRS complex which has no preceding P wave, rate is slower, around 55 beats per minute. When the heart rate increases to 75 beats per minute, QRS complexes become narrow again, so its sinus arrhythmia, with Competing sinus and idioventricular pacemakers, note that sinus capture occurs when the sinus rate exceeds the idioventricular rate. He is a healthy 32 year old professional football player with likely very high resting vagal tone causing intermittent idioventricular rhythm.
What is Idioventricular rhythm? Idioventricular rhythm is a slow regular ventricular rhythm, typically with a rate of less than 50, absence of P waves, and a broad QRS. When the SA node is blocked or suppressed, latent pacemakers become active to conduct rhythm secondary to enhanced activity and generate escape beats that can be atrial itself, junctional or ventricular. When ventricular rhythm takes over, it is called Idioventricular rhythm. Idioventricular rhythm is similar to ventricular tachycardia, except the rate is less than 60 bpm and is alternatively called a ‘slow VT’.
What is Accelerated idioventricular rhythm (AIVR)? Accelerated idioventricular rhythm (AIVR) results when the rate of an ectopic ventricular pacemaker exceeds that of the sinus node with a rate of around 50 to 110 bpm and often associated with increased vagal tone and decreased sympathetic tone. It is a hemodynamically stable rhythm and can occur after a myocardial infarction during the reperfusion phase.
SUBSCRIBE OUR CHANNEL FOR MORE : https://www.youtube.com/@cardionotes
#ecg #ekg #cardiology #howto #electrocardiograph #athlete