This was an interesting run.

[emt-b_wa]

one word. AGH!!!!!!

[Ridryder 911]

The Doc's got it.. SSS Something I don't like patient's to have ...

R/r 911

[Arachne]

:::waves a sign::: I'm a basic, some of this is over my head, so pardon me if this is a stupid question...

The website posted by ERDoc about SSS explains that this is a problem with the SA node and the atria that prevents normal pacemaking activity. It doesn't seem to imply any problem with the ventricles themselves, so stretches of bradycardia make sense (because the ventricles are working off their slower intrinsic rate*). Looking at the ECG, however (the second half of the second strip), there's that ~4 second stand-still. Why aren't the ventricles firing at their intrisic rate during that time?

Again, pardon me if this is a silly question.

[AZCEP]

The ventricles will provide an escape pacemaker site when the rate drops below their intrinsic rate of less than 40/minute. We would expect the junction to provide an escape at rates between 40-60/minute. In this case, my guess would be that this patient was on a medication to blunt this response, probably a beta blocker.

Now, when the heart is in diastole the coronary arteries are being perfused. While they are perfused the heart is receiving freshly oxygenated blood. As long as there is some oxygenated blood perfusing the myocardium, the escape pacemakers will not become irritated to the point where they take over the rhythm.

If this patient is on a SNS blocking agent, like a beta blocker, and the last contraction of the myocardium gives good perfusion to the coronary vessels, there is less reason to expect an escape pacemaker to take over. The fact that her mental status changed a bit during the pause, shows us that the forward movement of oxygenated blood was a problem.

[buckeyedoc]

:::waves a sign::: I'm a basic, some of this is over my head, so pardon me if this is a stupid question...

The website posted by ERDoc about SSS explains that this is a problem with the SA node and the atria that prevents normal pacemaking activity. It doesn't seem to imply any problem with the ventricles themselves, so stretches of bradycardia make sense (because the ventricles are working off their slower intrinsic rate*). Looking at the ECG, however (the second half of the second strip), there's that ~4 second stand-still. Why aren't the ventricles firing at their intrisic rate during that time?

Again, pardon me if this is a silly question.

That was by no means a silly question. At least you were mature enough to admit there was something you didn't know and wanted to learn about it.