The ECG reveals an irregular bradycardic arrhythmia, characterized by conduction abnormalities at the level of both SA node, as evidenced by the absence of some P waves, and the AV node, where the P waves fail to conduct to the ventricles to produce QRS complexes.

The coexistence of mixed conduction abnormalities in the context of end-stage renal disease (ESRD) raises suspicion for electrolyte imbalances as the primary etiology. This hypothesis was substantiated by laboratory findings indicating elevated levels of potassium (6.7 mg/dL) and decreased levels of calcium (7.1 mg/dL).

#case204 ❤️

A 90-year-old male with a known case of end-stage renal disease underwent an ECG due to experiencing dyspnea and chest pain.

The correct answer is “SA node block and Type 1 AVB”

The ECG demonstrates grouped beats. P-waves precede the QRS complexes with constant but prolonged PR intervals. This indicates a first-degree AV block.
Please note that P-wave is absent during the pause between the grouped beats. This pattern suggests an SA node block, rather than a second-degree AV block, in which a P-wave is present during the pause but is not followed by a QRS complex.

For more advanced users:
The P-P interval progressively shortens prior to the dropped P wave. The duration of the PP interval during the pause is less than twice the length of the shortest PP interval which is observed prior to the pause. This suggests a second-degree, Wenckebach sinoatrial block.

Special thanks to Dr. Salvatore for his expert ECG interpretation and the informative diagram he provided.

#extra8 ❤️

40 year old male with syncope

How does this ECG explain the symptoms?

Arrhythmogenic Right Ventricular Dysplasia
(ARVD)

A 75-year-old male with a known history of DM and HTN presented to the emergency department complaining of palpitations. Upon examination, his blood pressure was 140/90 mmHg, and O2 saturation was 94%.