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This patient had a total of three electrocardiograms.

One is an electrocardiogram with a serum potassium of 7.25mmol/l, one is an electrocardiogram after intravenous administration of atropine, and one is a separate ii lead electrocardiogram.

The patient is a 91-year-old female.

When the blood potassium was 7.25mmol/l, the electrocardiogram showed that the heart rate was only 37 beats/min, so the doctor on duty directly injected atropine intravenously.

These three pictures are indeed a mess!

This was the first time Lu Chen saw this form of electrocardiogram.

Especially the so-called "p" in various forms in these three pictures makes people very confused and clueless. No wonder they are unsolvable electrocardiograms.

"Does this first electrocardiogram have P waves?"

I don't know who asked in the group, and the originally noisy group suddenly became a little quiet.

After a long while, a doctor from the cardiology department of the county hospital spoke weakly: "The first electrocardiogram shows no p and no signs of reverse p. Isn't this sinus conduction?"

What's even more strange is that the T wave in the first picture is indeed very symmetrical, not the typical high peak.

The second picture is after intravenous administration of atropine. The T wave becomes very high and sharp, which is a typical electrocardiogram of hyperkalemia: Eiffel Tower-like T and tent-like T.

This picture was taken not long ago without taking any measures to lower blood potassium.

"No, I don't think it's sinus conduction."

The first person to raise objections was Comrade Lao Fan.

Logically speaking, if the above diagram shows sinus ventricular block, then this second diagram should also show sinus ventricular conduction!

But in the second picture, there are so many positive "p"s and the reverse "p"s appear, which is really strange!

"Director Fan, I know you have been studying electrocardiography and electrophysiology recently. Come and tell us about it so that everyone can learn."

Suddenly a doctor in the group suggested.

Most of them knew that Fan Zhiping participated in the ECG competition and even entered the second round.

Many people who are familiar with Fan Zhiping can't believe this result.

Originally, everyone's level was the same and mediocre. Why did Comrade Lao Fan suddenly explode?

Therefore, when some people asked Fan Zhiping to answer, most of them looked at it as a joke.

Especially the doctor who sent this picture. He has asked many people, even some directors of Jinghua No. 1 Hospital, but they don't have the exact answer. Can you, Fan Zhiping, do it?

But at this moment, Lu Chen was about to speak in the group when he saw Fan Zhiping sending a long message.

"We know that sinus-conducted hyperkalemia levels are more serious."

"Generally, the qrs wave will also widen, and the s wave in lead i will be very wide. You can also pay attention to the fact that the s wave in lead i of the electrocardiogram of patients with sinus ventricular conduction is relatively wide."

"But this patient's electrocardiogram showed no widening of the qrs wave, which was only 100ms. There was no S wave in lead i. The blood potassium was 7.25mmol/l, which was not particularly high. It did not reach above 8.5mmol/l. So the first step above There are many doubts in diagnosing sinus ventricular block."

After reading the message sent by Fan Zhiping, Lu Chen was quite surprised.

Comrade Lao Fan's ability to judge drawings has made great progress!

He is right, this first picture is not sinus conduction.

At this time, Fan Zhiping continued to speak: "The first picture should be a junctional escape rhythm. Because there is a very fixed inverse p after each qrs wave complex."

"From the macroscopic analysis, the first picture is still very clear that it is a junctional escape rhythm. After amplifying the electrocardiogram gain by 2 times, we can see that v1 and v2 have obvious inverse p, which is first negative and then positive in both directions."

"Then that picture may also be a junctional escape rhythm, not sinus ventricular conduction. As for why the reverse P is missing, is it because the atrioventricular node function improved after taking atropine, the conduction was accelerated, and the reverse P was buried in the qrs wave. , I can’t think of any other more reasonable explanation at the moment.”

"Hyperkalemia inhibits the sinoatrial node, causing sinus arrest, which leads to the possibility of junctional escape rhythm."

Comrade Lao Fan's speech finally ended, but the WeChat group exploded again!

Everyone saw Fan Zhiping's explanation.

The first time, I didn’t quite understand.

After reading it carefully a second time, I got a clue.

After reading it for the third time, I finally understood what he meant.

At this time, many people were surprised. Why did Fan Zhiping's electrocardiogram level suddenly rise so fast?

The most important thing is that he did not simply "look at the picture and speak", but deeply analyzed the electrocardiogram from the principle level of electrocardiogram.

"I think what Lao Fan said makes sense!"

"Well, if you look at it this way, sinus conduction has been ruled out!"

"I support Director Fan's diagnosis!"

After Fan Zhiping gave his reasons, many doctors in the WeChat group supported junctional escape rhythm.

Lu Chen thought for a while and replied: "I also support Director Fan!"

Lu Chen's speech sealed Fan Zhiping's diagnosis.

Everyone in the group saw "Professor Lu" and agreed with Lao Fan's statement, basically acquiescing to the diagnosis in the first picture.

At this time, the doctor who sent the picture asked again: "Teachers, the diagnosis is clear in the first picture, but what about the second picture, after the patient received atropine intravenously, what is this ECG?"

As soon as these words came out, everyone fell silent again.

In this second electrocardiogram, there are various positive "p"s and inverse "p"s, which are very complicated and confusing.

At the first time, Lu Chen was unable to interpret this picture.

If we simply look at the II lead, this picture looks like a third-degree atrioventricular block or interfering atrioventricular dissociation.

As expected, a doctor in the group immediately said, "Is the second picture a third-degree atrioventricular block?"

Lu Chen stared at the second ECG closely and shook his head slightly.

If it is a third-degree atrioventricular block or a high-degree atrioventricular block, why can the QRS wave after the reverse P always be transmitted?

Obviously, atrioventricular block cannot explain it!

Whether it is atrioventricular block or interfering atrioventricular dissociation, or atrioventricular block combined with interfering atrioventricular dissociation, it cannot explain this second ECG!

Everyone in the group talked about it, and everyone said that in addition to their own opinions, they also gave their own reasons.

But no one could convince anyone!

Lu Chen looked at the second picture carefully and was overwhelmed!

The "P" and reverse "P" in this picture appeared repeatedly, and UＵ看书 wwｗ． uukanshu． net even couldn't see any pattern.

You know, the first step in interpreting an electrocardiogram is to look at the p wave of the electrocardiogram.

But now there is a problem in the first step of interpreting the image!

Lu Chen took a deep breath and calmed himself down.

After this period of high-intensity electrocardiogram and electrophysiological training, although Lu Chen has made a lot of progress, the knowledge content is very complicated.

It is quite difficult for Lu Chen to mobilize all the knowledge points at the first time.

After calming himself down for a few minutes, Lu Chen began to think about this second electrocardiogram again.

Suddenly, an idea flashed through Lu Chen's mind.

"These so-called positive "p" and reverse "p" may be interference?"

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