Atrial Rhythms

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    62 year old female who is asymptomatic.

    62 year old female who is asymptomatic.


    Questions

    Question 1: What causes the differences in P wave morphology in wandering atrial pacemakers? 

    Question 2: Based on the the Lead II rhythm strip, what is one possible explanation for this patient's P wave changes? 

    Key Findings

    -Wandering Atrial Pacemaker

    Coding for the Boards

    - Sinus rhythm 
    - Left axis deviation 
    - Left ventricular hypertrophy
    - Wandering atrial pacemaker

    Answers

    Question 1: The different P wave morphologies occur because they are originating from different areas of the atrium. 

    Question 2: This patient may have a lower atrial rhythm (negative P wave in II) competing with sinus rhythm. As the sinus rate increases slightly, it usurps the lower atrial rhythm.