Kaisu Posted April 19, 2009 Share Posted April 19, 2009 the new pacemakers make the spikes very hard to see. I see it in V5. As for the question of BBB or ST elevations in a paced rhythm, abnormal depolarization means abnormal repolarization. Analysis of the 12 lead stops as soon as you ID a paced rhythm. Your monitors should have a pacemaker detect button, which will mark the pacing. I put that on whenever I have a patient with a pacemaker because that allows me to see if its a demand pacemaker or not and if it is demand, I want to see how often the patients underlying rhythm has to be paced. (of course, you can always ask the patient if they have one, and that big lump under the skin is a dead giveaway ) Link to comment Share on other sites More sharing options...
chbare Posted April 19, 2009 Share Posted April 19, 2009 It could be a paced rhythm, at this time I will assume non-paced because I can do a little more brain picking. Without a better image, I am hard pressed to definitively say it's a paced rhythm. Take care, chbare. Link to comment Share on other sites More sharing options...
celticcare Posted April 19, 2009 Share Posted April 19, 2009 Even squinting I can't see it and we are inserting modern pacemakers in patients here and even if they are demand or rate controlled pacers, they still show spikes on lead 2 most of the time or V1. I can't see anything, is there anyway you can put a circle on the pacing spike for us? Link to comment Share on other sites More sharing options...
chbare Posted April 19, 2009 Share Posted April 19, 2009 Look at V4 & V5, a little imagination, and you can see what could be pacing spikes. I passed them off as artifact; however, still a consideration. Take care, chbare. Link to comment Share on other sites More sharing options...
celticcare Posted April 19, 2009 Share Posted April 19, 2009 :bonk: My little eyes are all now cross eyed Link to comment Share on other sites More sharing options...
FL_Medic Posted April 20, 2009 Author Share Posted April 20, 2009 The idea behind these "strip teases" is to get a good discussion going, and some good guesses. I will have the true answer to this shortly, but as I said, I think it's paced. I may very well be wrong. Link to comment Share on other sites More sharing options...
FL_Medic Posted April 20, 2009 Author Share Posted April 20, 2009 The ANSWER This is a Sinus Rhythm with synchronous ventricular pacer. Link to comment Share on other sites More sharing options...
scott33 Posted April 20, 2009 Share Posted April 20, 2009 The ANSWER This is a Sinus Rhythm with synchronous ventricular pacer. Hmmm. One has to wonder if, given the atypical pacemaker rate, and the atypical delay in conduction between the atria and venrticles, that there isn't a technical issue with the pacemaker itself. May be time for the man with the magnet from Metronic, to interrogate the device Link to comment Share on other sites More sharing options...
FL_Medic Posted April 20, 2009 Author Share Posted April 20, 2009 Hmmm. One has to wonder if, given the atypical pacemaker rate, and the atypical delay in conduction between the atria and venrticles, that there isn't a technical issue with the pacemaker itself. May be time for the man with the magnet from Metronic, to interrogate the device ATRIAL SYNCHRONOUS PACEMAKER: SA node firing is sensed by pacemaker and using an AV interval the pacemaker generates ventricular contraction via intrinsic SA nodal firing. As with normal conduction, the SA node determines the rate, not the pacemaker. I believe this type of pacemaker is used when the SA node is still functional, but there is interference with the communication to the ventricles. So a pacer is used to bypass that problem. So the rate may seem atypical for a pacer, but it would be functioning normally. Link to comment Share on other sites More sharing options...
Kaisu Posted April 20, 2009 Share Posted April 20, 2009 thank you for this strip. Although I identified the pacemaker, I did not know about pacemakers that use a functioning SA node as a timer. I appreciate learning this. Link to comment Share on other sites More sharing options...
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