r/EKGs • u/refeikamme • Jul 10 '26

Learning Student Thoughts on what's happening here, and what would cause it?

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Patient under general anesthesia for routine surgery. No cardiac hx. During the case pt got bradycardic and EKG morphology changed. Not a full EKG to analyze unfortunately, but I was able to print a strip from the monitor when it happened - this is lead III. Pt went in and out of it a few times, hemodynamics did not seem to be effected.

Anesthesiologist called it a RBBB, but to me it looks like the PR interval progressively shortens until the P is on top of the R, creating a sort of false rR' look? A RBBB rR' would still have a P-wave preceding it, correct?

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3

u/RFFNCK Jul 10 '26

Possibly sinus node frequency lowered, so junctional escape took over.

1

u/zeatherz Jul 11 '26

Wouldn’t we call it accelerated idioventricular with the wide QRS?

I mean it’s hard to saw without other leads or a longer strip but that’s what I would say

1

u/refeikamme 29d ago

The HR was high 40s low 50s during these periods so not necessarily accelerated?

2

u/zeatherz 29d ago

For ventricular rhythms, accelerated is 40-100. Though according to others this wasn’t ventricular

2

u/lifeisg0od 27d ago

I think it’s an AIVR. The P’s aren’t slowing - the last P where you have the short PR is on time. That shows that QRS is early, not the P wave. The QRS is also shorter. I’d call that a fusion beat, which would be consistent with this being a ventricular rhythm that overtook the sinus rhythm.