12 lead ecg shows 2 p waves within a PR interval of .24 seconds. The p waves are different shapes--the first p wave is normal shape, the second p wave is smaller and a little more peaked. But the p waves are very distinct. The patient does not have an av block or atrial flutter or atrial tach. The pattern is consistent through the 12 lead. The patient has no known cardiac history.
I've never heard about such a rhythm, unfortunately (but I'm not a healthcare professional).
At PR .24 seconds, the patient has an AV block (1st degree). He could suffer an intra-atrial conduction disturbance or an enlarged left atrium, but if so, the P wave would usually be markedly negative in V1. In other words a biphasic P wave.
Do the P and the P' wave have similar axis? If so, maybe you are seeing a biphasic P wave (as mentioned above). I strongly doubt the case is an ectopic P wave (atrial bigeminy) so close to the normal P wave. As mentioned, I have never heard about depolarizations happening before the QRS complex, and if it happened, it would very likely trigger atrial fibrillation.
Sorry I can't provide a better answer. Maybe you should ask an MD.
I think this may have been someone studying for a certification exam. I see these academic-style questions pop up on here once in a while.
The is written just like a cert or board exam question stem.
"The patient has no known cardiac history." tells me this isn't about the poster.
I'm troubled by it when I see it because if this is how the person figures things out (basically cheating) they probably have poor diagnostic skills. I'm sorry to the original poster if I'm wrong, please do correct me if that's the case.
Is there a picture of the strip or 12-lead? My first thought would be some sort of artifact. It's hard to answer though without actually seeing it. Are you sure that both are p waves and not the t wave and p wave? Another thought would be regular nonconducted PACs.
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