I Can See Health

   Chapter 285 Interference

   This patient has a total of three ECGs.

   One is an electrocardiogram with serum potassium 7.25 mmol/L, one is an electrocardiogram after intravenous atropine, and one is a separate lead II electrocardiogram.

   The patient is a 91-year-old female.

  When the serum potassium was 7.25mmol/L, the heart rate was only 37 beats/min on the electrocardiogram, so the doctor on duty directly injected atropine.

   These three pictures are really messy!

   This is the first time that Lu Chen has seen this type of electrocardiogram.

  Especially the so-called "P" in various forms in these three pictures makes people very confused and clueless, no wonder it is an unsolved electrocardiogram.

   "Does this first ECG have P waves?"

   I don't know who asked in the group, the originally noisy group became a little quiet for a while.

   After a long while, a doctor from the Cardiology Department of the county hospital said weakly: "The first ECG, there is no P, and there is no trace of inverse P. Isn't this sinus conduction?"

   And what is even more strange is that the T wave in the first picture is indeed very symmetrical, not the typical high point.

  The second picture is after atropine is pushed, and the T wave becomes very high and sharp, typical hyperkalemia ECG: Eiffel Tower T and tent T.

   This picture was made after a short period of time and without any blood potassium-lowering measures.

   "No, I don't think it's sinus conduction."

   Comrade Lao Fan was the first to raise an objection.

  It stands to reason that if the above picture is a sinus block, then the second one should also be a sinus conduction!

  But the second picture ran so many positive "P"s, and the inverse "P" came out, which is really strange!

   "Director Fan, I know that you have been studying electrocardiography and electrophysiology recently. Come and tell us about it, and let everyone come to learn."

   A doctor suddenly suggested in the group.

   Most of them know that Fan Zhiping participated in the electrocardiogram competition and entered the second round.

  Many people who are familiar with Fan Zhiping can't believe this result.

   Originally, everyone's level was the same, and they were just as unremarkable. Why did Comrade Fan suddenly break out?

   Therefore, when someone asked Fan Zhiping to answer, most of them were joking.

  Especially the doctor who posted this picture, he has already asked many people, even some directors of Jinghua No. 1 Hospital, and they have no definite answer. Can you, Fan Zhiping, be okay?

   But at this moment, Lu Chen was about to speak in the group when he saw Fan Zhiping send a very long message.

   "We know that the level of hyperkalemia in sinus ventricular conduction is more severe."

   "Generally, the widening of the QRS complex will also occur, and the S wave in lead I will be very wide. You can usually pay attention to the S wave in lead I of the ECG of patients with sinus conduction."

"But this patient's ECG QRS wave did not widen, it was only 100ms, and there was no S wave in lead I, and the blood potassium was 7.25mmol/L, which was not particularly high, and did not reach more than 8.5mmol/L. Therefore, the first There are many doubts about the diagnosis of sinus block.”

   After reading the message sent by Fan Zhiping, Lu Chen was quite surprised.

   Comrade Lao Fan's judging level has made great progress!

   He was right, this first picture is not sinus conduction.

   At this time, Fan Zhiping continued to speak: "The first picture should be a junctional escape rhythm. Because each QRS complex has a very fixed inverse P."

   "From the macroscopic analysis, the first picture is still very clear that it is a junctional escape rhythm. After multiplying the ECG gain by 2 times, it can be seen that V1 and V2 have obvious inverse P, and the bidirectional first negative and then positive."

"Then that picture may also be a junctional escape rhythm, not sinus ventricular conduction. As for why the inverse P is missing, is the atrioventricular node function improved after atropine is used, the conduction is accelerated, and the inverse P is buried in the QRS complex. , I can't think of any other more reasonable explanation at the moment."

   "Hyperkalemia appears to suppress the sinus node, and sinus arrest occurs, thus resulting in the possibility of a junctional escape rhythm."

   Lao Fan’s speech finally ended, but the WeChat group exploded again!

   Everyone saw Fan Zhiping's explanation.

   For the first time, I didn’t quite understand it.

   After reading it a second time, I got a clue.

   After watching it a third time, I finally understood what he meant.

   At this time, many people were surprised, why did Fan Zhiping's ECG level suddenly rise so fast?

   The most important thing is that he did not simply "see the picture and talk", but deeply analyzed this electrocardiogram from the principle level of the electrocardiogram.

   "I think Lao Fan is right!"

   "Well, looking at it this way, sinus conduction is ruled out!"

   "I support Director Fan's diagnosis!"

  After Fan Zhiping gave his reasons, many doctors in the WeChat group supported the junctional escape rhythm.

  Lu Chen thought about it and replied, "I also support Director Fan!"

  Lu Chen's speech concluded Fan Zhiping's diagnosis.

   Everyone in the group saw "Professor Lu" and agreed with Lao Fan's speech, and basically acquiesced to the diagnosis in the first picture.

   At this time, the doctor who sent this picture asked again: "Teachers, the first picture has a clear diagnosis, and in the second picture, after the patient was intravenously pushed atropine, what is this electrocardiogram?"

   As soon as these words came out, everyone was silent for a while.

   In this second electrocardiogram, various positive "P" and inverse "P" are very complicated and confusing.

   In the first place, Lu Chen couldn't read this picture either.

   If you look at lead II in this way, this one looks like a third degree AV block or interfering AV dissociation.

   Sure enough, a doctor in the group immediately said, "Is the second picture a third-degree atrioventricular block?"

  Lu Chen stared at the second electrocardiogram, then shook his head slightly.

  If it is a third-degree AV block or a high-grade AV block, why is the QRS complex behind the inverse P always conducted?

   Apparently AV block cannot be explained!

   Whether it is AV block or interfering AV dissociation, or AV block combined with interfering AV dissociation, this second ECG cannot be explained!

   Everyone in the group was talking, and everyone said that in addition to their own opinions, they also gave their own reasons.

   But no one can convince anyone!

  Lu Chen looked at the second picture carefully, his head became bigger!

   The "P" and the inverse "P" appear repeatedly in this picture, and we can't even see any regularity.

  You must know that the first step in interpreting an electrocardiogram is to look at the P wave of the electrocardiogram.

   But now, in the first step of judging the map, there is a problem!

  Lu Chen took a deep breath to calm himself down.

   After this period of high-intensity ECG and electrophysiology training, although Lu Chen has made a lot of progress, the content of his knowledge is very complicated.

   It is quite difficult for Lu Chen to mobilize all the knowledge points at the first time.

   After calming himself down for a few minutes, Lu Chen started thinking about the second ECG again.

   Suddenly, an idea flashed in Lu Chen's mind.

   "These so-called look like positive "P" and reverse "P", could it be possible interference?"

   (end of this chapter)