Agonal Junctional Tachycardia

Report:

Sinus bradycardia

Junctional tachycardia

AV dissociation

VEBs, bigeminy (below)

Second degree AV block, 2:1 (middle strip)

Third degree AV block, ventricular standstill

(Agonal) ST segment elevation

Comment:

The last part of a normal human heart to cease electrical activity is the right atrium, perhaps represented here by the positive P wave (initially triphasic) in the MCL1.

The run of bigeminy shown below (Fig 250a) occurred two minutes after the ventricular standstill recorded on the original strips. Agonal rhythms often recover electrical activity just as one thinks it’s all over. It may be of some clinical importance in that it may startle the assembled family whose eyes tend to become fixed on the monitor. The (presumptive) VEBs here look more normal than the supraventricular QRS complexes; such are the limitations of a single lead.

Shallow atrial repolarisation (Ta wave) is well shown in the bottom strip of the original recording.

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