The presence of multiple P wave morphologies indicates multiple ectopic pacemakers within the atria and/or AV junction. If ≥ 3 different P wave morphologies are seen, then multifocal atrial rhythm is diagnosed:

The presence of multiple P wave morphologies indicates multiple ectopic pacemakers within the atria and/or AV junction. If ≥ 3 different P wave morphologies are seen, then multifocal atrial rhythm is diagnosed:

We therefore interpret this tracing as showing “AV dissociation” – since at least some P waves are unrelated to the QRS complexes that follow them. The term AV dissociation should never be used as a “diagnosis” per se.  Instead – it is the result of the underlying rhythm on the tracing.  In this case – the underlying rhythm is sinus bradycardia at a rate of 50/minute (the P-P interval is precisely 6 large boxes in duration for each of the P waves on this tracing). AV dissociation occurs by…

We therefore interpret this tracing as showing “AV dissociation” – since at least some P waves are unrelated to the QRS complexes that follow them. The term AV dissociation should never be used as a “diagnosis” per se. Instead – it is the result of the underlying rhythm on the tracing. In this case – the underlying rhythm is sinus bradycardia at a rate of 50/minute (the P-P interval is precisely 6 large boxes in duration for each of the P waves on this tracing). AV dissociation occurs by…

Junctional Rhythms: P wave might be present, absent, buried in QRS or present after the QRS (RETROGRADE CONDUCTION)

Junctional Rhythms: P wave might be present, absent, buried in QRS or present after the QRS (RETROGRADE CONDUCTION)

Accelerated Junctional Rhythm: occurs when the rate of the AV junctional pacemaker exceeds that of the sinus node. This situation arises when there is increased automaticity in the AV node coupled with decreased automaticity in the sinus node. Causes include myocardial ischaemia, digoxin toxicity, cardiac surgery, myocarditis and beta-agonists (e.g. isoprenaline).

Accelerated Junctional Rhythm: occurs when the rate of the AV junctional pacemaker exceeds that of the sinus node. This situation arises when there is increased automaticity in the AV node coupled with decreased automaticity in the sinus node. Causes include myocardial ischaemia, digoxin toxicity, cardiac surgery, myocarditis and beta-agonists (e.g. isoprenaline).

"'Everything you create is a representation of something else; in this sense, everything you create is enriched by metaphor'" (p. 139).

"'Everything you create is a representation of something else; in this sense, everything you create is enriched by metaphor'" (p. 139).

[What are those funny looking beats????]{Frank G. Yanowitz, M.D.}The differential diagnosis of funny-looking-beats, or FLB's, primarily considers beats of supraventricular origin with aberrant conduction and ventricular ectopic beats. In this example the two FLB's have an easily seen ectopic P wave before them; therefore these are PAC's with RBBB aberration.

[What are those funny looking beats????]{Frank G. Yanowitz, M.D.}The differential diagnosis of funny-looking-beats, or FLB's, primarily considers beats of supraventricular origin with aberrant conduction and ventricular ectopic beats. In this example the two FLB's have an easily seen ectopic P wave before them; therefore these are PAC's with RBBB aberration.

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