Assoc Prof Harry Mond
March 4, 2025
32 year-old one legged ballerina with acute gout in the amputated leg.
Overnight tracings from Holter monitor recording. There is a pause (red highlight).
What do you think?
The top tracing is Wenckebach second degree AV block.
There is an increasing PR interval (red horizontal arrows) and 2:1 AV block. Such findings are common in the young overnight and are the result of vagal hypertonia.
What is the significance of the two non-conducted P waves?
The first non-conducted P wave (red highlight) times out as a sinus P wave. The second is a non-conducted atrial ectopic, structurally different from the sinus P waves
The timing of the non-conducted atrial ectopic (yellow highlight) can be before or after the non-conducted sinus P wave (red highlight), even in the same patient.
It’s all in the timing.
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May 14, 2025
Fusion is another lesson in timing! Fusion beats are an amalgam of two competing rhythms. Both are responsible for partial depolarization of the respective chambers and depending on the contribution of each, result in progeny with similarities to one or both parents.
May 14, 2025
The ventricular ectopic compensatory pause is a lesson in timing!
