Atrial Rhythms

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    85 year old asymptomatic female.

    85 year old asymptomatic female.

    Questions

    Question 1: Why does this patient have such low amplitude P waves?

    Key Findings

    -Sinus bradycardia with low voltage P waves

    -First degree AV block

    Coding for Boards

    -Sinus Bradycardia

    -First degree AV block

    Answers

    Question 1: This patient may have diffuse atrial electrical disease, reducing the amplitude of the P waves. The same process in the AV node could be responsible for the first degree AV block. Even though the P waves are difficult to discern in some leads, the rhythm is likely sinus based on the upright P wave morphology in leads III and AVF.