Atrial Rhythms

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    84 year old female with dyspnea and neck tightness.

    84 year old female with Dyspnea and neck fullness.

    Questions

    Question 1: What is the cause of this patient's dyspnea and neck fullness?

    Question 2: What are some possible causes for an accelerated junctional rhythm?

    Key Findings

    -Sinus rhythm with competing junctional rhythm

    Coding for Boards

    -Sinus rhythm

    -AV junctional rhythm/tachycardia

    -Nonspecific ST and/or T wave abnormalities

    -Left atrial abnormality

    Answers

    Question 1: In this situation, the ventricle and atrium contract at nearly the same time. This results in atrial contraction against a closed AV valve which can result in the above symptoms.

    Question 2: Digitalis toxicity, Beta-agonists, Ischemia, and Cardiac Surgery.