EKG of the Week
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+ EKG Interpretation
Dr. Ohlbaum's Explanation
The rhythm is quite slow but it is regular. There are no P waves (there are a couple of "glitches" but they do not march thru and are artifact). The QRS is narrow. There are small Q waves in the inferior leads that are possibly significant. There are T wave inversions in the inferior and lateral leads.
This is a junctional bradycardia at a rate of 36. There is a possible old inferior Ml and inferolateral ischemia.
Now I will give you the rest of the story. This is a frail elderly man with known CAD. He had been hospitalized at an outside hospital the week before for a PCI and on discharge they had changed him from verapamil to metoprolol. But he did not quite understand, so instead of stopping the verapamil, he just left it in his mediset and ADDED the metoprolol to it. This is a result of that overmedication. He required several days of pacing and pressors but it eventually resolved.
Further Reading:
- Life in the Fast Lane: Junctional Escape Rhythm
