UMEM Cases, Part 3: When the Diagnosis Seems Clear and When It Is Not

UMEM Potpourri ECG Cases with Dr. Amal Mattu

HPI

A 71-year-old man presents with shortness of breath, and his ECG is initially read as a junctional rhythm. On later review, it is even mistaken for atrial fibrillation. But the rhythm is actually regular, and closer inspection reveals subtle atrial activity. The diagnosis depends on recognizing what is and is not a true P wave, and on not mistaking buried atrial activity for part of the T wave.

Before watching this week’s workout, review the arrival ECG carefully and consider:

    1. What ECG features help distinguish a buried P wave from terminal T wave morphology?
    2. When a rhythm looks junctional at first glance, what clues should push you to search every lead for hidden sinus activity?
    3. How would you interpret and document this rhythm?