Ventriculophasic Sinus Arrhythmia

Report:

Sinus rhythm

Ventriculophasic sinus arrhythmia[!xe "Ventriculophasic sinus arrhythmia" \b!]

2:1 Second degree AV block

Non-specific T wave changes[!xe "P wave:mime by U wave" \b!]

Comment:

This trace shows that the ventriculophasic effect can mislead even a Cardiologist into error. Morphologically, U waves are usually rounder and longer than this. In the rhythm strip, the putative U waves can be seen to be identical to the P waves – there’s no excuse.

The P waves surrounding a QRS complex in 2:1 or higher AV block are closer together than "empty" P-P intervals in approximately 30% of cases.

The block cannot be characterised as to its Möbitz type since no two consecutive P waves are conducted; it’s simply 2:1 block.

The lateral (1, aVL) T waves are abnormal. In Lead 1, T wave should be taller than in Lead 3, unless the heart is in vertical position (aVL and aVF converging). In aVL, T can be inverted, especially if P wave is also negative and the R wave is 5mm or less in height. The R wave here is almost 7 mm in height. T wave changes like this can be an early sign of either LVH or ischæmia.