Anterior MI: Bigeminal VEBs with Retrograde Conduction
Report:
Sinus rhythm 56 â 64/min
Left atrial abnormality (LAA)
VEBs, bigeminal
Retrograde VA conduction
Acute anterior infarction
Comment:
It would be redundant to report poor R wave progression in the face of obvious anterior infarction (the computer did it, but missed the infarct). It may indicate a previous infarction of the anterior wall, but this speculation is best left unmentioned.
The VEBs are followed by typical retrograde P waves, inverted in the inferior leads and upright in the other three frontal leads. They are very likely to have slowed the sinus rhythm through post-ectopic SA depression and reduced the effective heart rate to about 30/min, explaining the hypotension58. The VEBs often have little or no capacity to contribute to cardiac output.
The next day (Fig 83a) the patient had multiple atrial ectopics. The first beat is one, with RBBB/LAHB aberrancy and a distinctive Pâ preceding it. The VEB in the middle of the trace starts (or precedes) a triplet of atrial tachycardia. The second VEB looks interpolated, but is in fact sandwiched between an atrial beat and a sinus one. The retrograde conduction is no longer present.
Dingchang Zheng, John Allen and Alan Murray 83a.
84. 83 year old lady day after admission to CCU.
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