The presence of multiple P wave morphologies indicates multiple ectopic pacemakers within the atria and/or AV junction. If ≥ 3 different P wave morphologies are seen, then multifocal atrial rhythm is diagnosed:

The P wave on the ECG. Interpretation and clinical significance of P wave morphological changes

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Mitral Stenosis - Wide Notched P wave ... 【 Note : Wide P wave in Left atrial enlargement, Tall P wave in Right atrial enlargement 】

Mitral Stenosis - Wide Notched P wave . 【 Note : Wide P wave in Left atrial enlargement, Tall P wave in Right atrial enlargement 】

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If ≥ 3 different P wave morphologies are seen and the rate is ≥ 100, then multifocal atrial tachycardia (MAT) is diagnosed:

If ≥ 3 different P wave morphologies are seen and the rate is ≥ then multifocal atrial tachycardia (MAT) is diagnosed:

We interpret this tracing as showing “AV dissociation”- since at least some P waves are unrelated to the QRS complexes that follow them. The term AV dissociation should never be used as a “diagnosis” per se. Instead...it is the result of the underlying rhythm on the tracing. In this case, the underlying rhythm is sinus bradycardia at a rate of 50/min (the P-P interval is precisely 6 large boxes in duration for each of the P waves on this tracing).

The lead II rhythm strip shown below in Figure 1 was obtained from an asymptomatic middle-aged adult. Is there complete ( degree ) AV .

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p waves | ... there is no relationship between the p waves and the qrs complexes

The treatment for unstable third-degree AV block in ACLS is transcutaneous pacing.

Accelerated Junctional Rhythm: occurs when the rate of the AV junctional pacemaker exceeds that of the sinus node. This situation arises when there is increased automaticity in the AV node coupled with decreased automaticity in the sinus node. Causes include myocardial ischaemia, digoxin toxicity, cardiac surgery, myocarditis and beta-agonists (e.g. isoprenaline).

Accelerated junctal rythem when av junctal pace maker is faster than sinuous

Junctional Rhythms: P wave might be present, absent, buried in QRS or present after the QRS (RETROGRADE CONDUCTION)

Junctional Rhythms: P wave might be present, absent, buried in QRS or present after the QRS (RETROGRADE CONDUCTION)

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