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Orthopedics

A 54 year old male is admitted with an anterior myocardial infarction and receives thrombolytics.  Twelve hours later, his EKG has changed. The patient has had no further chest pain and has no signs of heart failure.  His blood pressure is 130/70. What does the EKG show and what is the diagnosis?

Rate:    50

Rhythm:  Idioventricular with occasional sinus beat

Axis:    Left axis

P:   Normal

PR:    Normal

QRS:   LBBB morphology

EKG diagnosis: Idioventricular rhythm

Clinical diagnosis:  Postinfarct idioventricular rhythm

Treatment: Observation, may try atropine if hypotensive. Do NOT give lidocaine

• Practice Points: -This is a common arrhythmia following MI
• -It is due to spontaneous pacemaker function originating within or below the AV node
• -It is not usually associated with hemodynamic compromise and does not require any treatment
• - It is often seen as an escape phenomenon. Atropine will increase the sinus rate which will often abolish the idioventricular rhythm

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