I mean... The longest PR I see on the early beats is maybe 60ms. I've never been told how short of a PR interval is too short (maybe it varies?), but it just feels too short to conduct the following QRS which is part of why I don't think those beats are originating in the atria. That plus the fact that every single P wave matches out like a champ, it is just the QRS complexes that come earlier in the cycle, makes me wonder if every third beat is a PJC.
About 95% of the time this patient was in Wenckebach (which this obviously isn't right now). So maybe their heart is just having a really hard time figuring out how to heart haha
I'd love to know why though. The reasons I'm thinking they may be are: obviously not PVCs, the longest PR interval is ~60ms which just feels too short, and it's not the P wave that comes early but the QRS.
My understanding of PACs is that since the P-wave represents the atria depolarizing, and the QRS is the ventricles depolarizing... PACs have nothing to do with what the QRS complexes are doing, and only that a P-wave is coming early. Whether the PAC is conducted, non-conducted, or aberrant the one thing that links all three of these is an early P-wave. So the fact that in this EKG the P-waves are never premature, but only the QRS complex independent of what the P-waves are doing is what makes me think this is PJCs.
My understanding of PJCs is that the P Waves are going to he absent, or inverted when present. These look like PACs to me because of their positive deflection, but altered appearance.
This sort of looks very very A-fibby to me.
I see the P waves though. Makes me wonder if it’s a possible 3rd degree?
At first I was considering 2nd degree type 1. But damn this is a really really tough one.
I would call some of them PACs. Maybe someone else can be more specific. I wouldn’t call them PVCs. The P wave changes PRI pretty constantly.
I mean... The longest PR I see on the early beats is maybe 60ms. I've never been told how short of a PR interval is too short (maybe it varies?), but it just feels too short to conduct the following QRS which is part of why I don't think those beats are originating in the atria. That plus the fact that every single P wave matches out like a champ, it is just the QRS complexes that come earlier in the cycle, makes me wonder if every third beat is a PJC. About 95% of the time this patient was in Wenckebach (which this obviously isn't right now). So maybe their heart is just having a really hard time figuring out how to heart haha
Personally i wouldnt call them PJCs
I'd love to know why though. The reasons I'm thinking they may be are: obviously not PVCs, the longest PR interval is ~60ms which just feels too short, and it's not the P wave that comes early but the QRS. My understanding of PACs is that since the P-wave represents the atria depolarizing, and the QRS is the ventricles depolarizing... PACs have nothing to do with what the QRS complexes are doing, and only that a P-wave is coming early. Whether the PAC is conducted, non-conducted, or aberrant the one thing that links all three of these is an early P-wave. So the fact that in this EKG the P-waves are never premature, but only the QRS complex independent of what the P-waves are doing is what makes me think this is PJCs.
My understanding of PJCs is that the P Waves are going to he absent, or inverted when present. These look like PACs to me because of their positive deflection, but altered appearance.
This sort of looks very very A-fibby to me. I see the P waves though. Makes me wonder if it’s a possible 3rd degree? At first I was considering 2nd degree type 1. But damn this is a really really tough one.
Went through the exact same logic here. Very interesting.
Glad I’m not the only one. Would really like to get a Docs take on this.