Sinus Arrest: Asystole

Report:

Sinus rhythm 60 – 70/min

First degree AV block (PR 0.24”)

Second degree AV block (unspecified - movement artefact over the last conducted P wave)

Sinus arrest (middle)

Sinus tachycardia 104/min (bottom)

Third degree AV block

Junctional escape rhythm 35/min

Comment:

One would have expected ventricular asystole from AV block, but it came from sinus arrest instead.

Atropine did little for this patient, although it may have been, literally, precious little in this case! It is always used first, and is generally held to be innocuous. This is not always so: it may waste valuable time in actual arrests, and it has side effects of its own. It may increase the degree of block even in the setting of inferior infarction - as in this case. Still, it had a place in this particular circumstance. Had I been there, I would have reached for something stronger!

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