Acute Extensive Anterior Infarction: Junctional Rhythm

Report:

Junctional rhythm 47/min

Acute extensive anterior infarction

Comment:

There are some semantic problems here. A single dissociated P wave – very likely sinus – is seen just before the last QRS complex. Should sinus rhythm be reported as well? Other sinus P waves may be hiding within the QRS complexes, or replaced by similarly placed retrograde P waves, or there may be no atrial activity. Should AV dissociation be included in the report?

It is best to omit the minutiae in cases like this. There’s enough to think about as it is.

Below (Fig 42a) is a sinus rhythm trace taken the following day, showing the expected evolution of the infarct. There is some R wave loss but no Q waves.

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