Small Ectopics
Report:
Sinus rhythm.
VEBs.
Junctional escape beats.
AV dissociation.
Retrograde conduction (of VEBs).
Comment:
The small complexes are probably VEBs, although aberrant junctional beats cannot be excluded. A 12-lead ECG would help. Note the mirror-image (down-up instead of up-down) appearance of the retrograde atrial waves.
Below (Fig 210a) is a different patient's strip showing similar small VEBs in the Marriott lead. It is at times easy to mistake them (or part of them) for P waves.
210a. On second thoughts, the FLBs could be supraventricular, aberrant with diminished, as expected, S wave, and a nascent Râ wave? Unlikely, more leads would tell.
- 211. 70 year old woman with chest pain, intubated after VF cardioversion in Casualty.
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