Ventriculophasic Sinus Arrhythmia

Report:

Sinus rhythm

Ventriculophasic sinus arrhythmia[!xe "Ventriculophasic sinus arrhythmia" \b!]

2:1 Second degree AV block

Non-specific T wave changes[!xe "P wave:mime by U wave" \b!]

Comment:

This trace shows that the ventriculophasic effect can mislead even a Cardiologist into error. Morphologically, U waves are usually rounder and longer than this. In the rhythm strip, the putative U waves can be seen to be identical to the P waves – there’s no excuse.

The P waves surrounding a QRS complex in 2:1 or higher AV block are closer together than "empty" P-P intervals in approximately 30% of cases.

The block cannot be characterised as to its Möbitz type since no two consecutive P waves are conducted; it’s simply 2:1 block.

The lateral (1, aVL) T waves are abnormal. In Lead 1, T wave should be taller than in Lead 3, unless the heart is in vertical position (aVL and aVF converging). In aVL, T can be inverted, especially if P wave is also negative and the R wave is 5mm or less in height. The R wave here is almost 7 mm in height. T wave changes like this can be an early sign of either LVH or ischæmia.

Fig 44. 60 year old man with abdominal pain, dry retching and nausea due to an exacerbation of idiopathic cardiomyopathy. Explain the middle strip.