Junctional Rhythm

Question: Are the atria of a patient with a junctional rhythm contracting? since there are no p waves present on the EKG with a patient with a junction rhythm, does that mean that their atria are not pumping and contracting sending blood to the ventricles?

Answer: The atria are still contracting. In a junctional rhythm a p wave is present, it's just inverted. This occurs because the atria don't contract first like they do in a normal rhythm, instead, the ventricles contract first, then the atria.

Question: I have a junctional rhythm? I had an EKG done during my surgery and the nurses told me that I need to see a cardiologist because I have a junctional rhythm. A nurse friend of mine saw my EKG strips and started freaking out when she saw them. I am only 24 and have always been healthy. She said something about a pacemaker!!! I cannot get into the doctor until next week and now I'm stressing out big time. Can anyone explain what could be going on?

Answer: Relax, you have done all the right things. This is treatable condition. Here is a link that gives you a lot of technical info on junctional rhythms. I would not worry too much. Good luck! CC

Question: accelerated junctional rhythm??? what does this mean and is it dangerous? I had a large part of my sinus node removed in a ablation of my heart 2 months ago. I now am experiencing chest pain and tighness in my thraot.

Answer: get in to your er or doc now. Who cares what it is, the symptoms are scary...any chest pain in somebody with that history is ominous.

Question: Sinus Heart Rhythms...? Can anyone tell me where I can find the description and treatment of the following heart rhythms : 1.)Junctional Rhythm 2.)1st degree 3.)2nd degree type II 4.)3rd degree If you can, can you please send me the information or the link to the website. I am in desprate need! ***This is serious, so please, no silly answers*** Thanks to all.

Answer: 1. Junctional Rhythm: 3 basic types. (a) AV nodal escape rhythm 40-60bpm. This occurs when the SA node is delayed or fails in its pacemaking function; (b) Accelerated junctional rhythm 61-99bpm. The junctional rate speeds up and takes over the pacemaking function; (c) Junctional tachycardia >100bpm. Normally the AV nodal escape rhythm is 40-60bpm. If higher and the pt. is on dig, test for dig levels and toxicity. AV nodal escape rhythm may be monitored with no treatment given at that time. A bradycardic rhythm may be treated with atropine, dopamine, epi, isoproterenol (just until a transcutaneous or transvenous pacer is placed). The tachy rhythms can be txd with beta-blockers, dig, Diltiazem, Ca channel blockers, amiodarone or cardioversion. 2. 1st degree AV block: Defined as a prolongation of the PR interval >200 msec. Tx depends on the degree of block. Monitor. Usually pacing if severe enough. 3. 2nd degree type II AV block: This is the Mobitz block. There are 2 consecutive and constant PR intervals before a blocked P wave. Almost always in the bundle branches so that means the QRS is wide (complete block of one bundle) and the P wave is blocked in the other bundle. The tx is pacer. 4. 3rd degree AV block: Complete block. Usually there's a complete AV dissociation because the atia and the ventricles are each controlled by separate and different pacemakers. A narrow QRS suggests a junctional escape focus for the ventricles with a block above the pacemaker focus, usually in the AV node. And a wide QRS suggests a ventricular escape focus. Tx is a ventricular pacemaker. But if due to adverse effect of antiarrhythmics, the med is D/C'd but still need a pacer. Hope this helps you out.

Question: medical professionals help? i have postural ortho static tachycardia syndrome.? i just got a pacemaker for accelerated junctional rhythm. now my ekg said short pr interval.What is that? can a pacemaker help tachycardia. my heart goes to 200 with excertion or stairs-hills. he put me on midogrin 10 mg. 3x a day.

Answer: What is Postural Tachycardia Syndrome? Postural tachycardia syndrome (POTS) is a disorder characterized by a pulse rate that is too fast when the patient stands. Symptoms include rapid heartbeat, lightheadedness with prolonged standing, headache, chronic fatigue, chest pain, and other nonspecific complaints. Causes of POTS usually are not identified in individual patients. Reversible causes such as low blood volume should be ruled out. Is there any treatment? Treatment of POTS depends upon the severity of the symptoms. Individuals with the disorder are usually advised to increase their fluid and salt intake. Body stockings may provide some relief. Drug therapy, with fludrocortisone, beta-blockers, midodrine, or clonidine, can be beneficial. Physical exercise, especially calf muscle resistance training, also may help. Some patients may require and benefit from insertion of a cardiac pacemaker. An accelerated junctional rhythm (rate >60) is a narrow complex rhythm that often supersedes a clinically bradycardic sinus node rate. The QRS complexes are uniform in shape, and evidence of retrograde P wave activation may or may not be present. Midodrine (MI-doe-dreen) is a medicine used to treat low blood pressure (hypotension). It works by stimulating nerve endings in blood vessels, causing the blood vessels to tighten. As a result, blood pressure is increased. Midodrine is an alpha-sympathomimetic drug. It is used to treat hepatorenal syndrome and orthostatic hypotension.It is not given before bedtime to avoid supine hypertension; the last dose of midodrine should be taken at least 3 to 4 hours before bedtime. Please see the web pages for more details on Postural orthostatic tachycardia syndrome and Midodrine (not midogrin).

Question: ECG results please explain? I understand that Mr SUPERSTARDJ01 attended for an ambulatory blood pressure monitor on 7 August 2009. His clinic blood pressure reading was 141/83, pulse rate 39 beats per minute. The ECG showed bradycardia at the rate of 40 beats per minute likely to be junctional rhythm as no P waves were seen on the trace. We have attempted fitting him with an ambulatory blood pressure monitor but the monitor was unable to take his readings in view of the significant bradycardia. I trust that we need to investigate Mr SUPERSTARDJ01’s cardiac rhythm as he may have higher degree heart block and may require cardiac pacing. It is possible that his blood pressure readings may be high due to the bradycardia causing larger stroke volume. We will attempt to make contact with him in the near future for the monitor but he should report any occurrence of dizziness, faints or blackouts. Thank you for your referral. I am felling hot/hot flushes, getting palpitations and having difficulties breathing so the doc has given me an inhaler for now while I wait for the results of the mobile ECG. Additional Details Further to my recent letter regarding Mr SUPERSTARDJ01. He has now had a 24-hour ECG that was done on 17 August 2009. It showed extreme bradycardia with a mean heart rate of 38 beats per minute, maximum heart rate 85 beats per minute around 6:35 a.m., minimum heart rate 28 beats per minute around 8:50 p.m. The trace shows extreme bradycardia with probably no atrial activity seen, probable atrial standstill with junctional rhythm or complete heart block. The heart accelerated to 85 beats per minute only briefly around 6 a.m. We have not detected atrial fibrillation or wide complex tachycardia. The accompanying diary reports occurrence of palpitations, the feeling of missed beats, hot flushing and occasional shortness of breath. This extreme bradycardia may explain raised blood pressure readings in view of the probable increased pulse pressure that is caused by the bradycardia. The maximum heart rate occurred at around 6 a.m., the accompanying diary reports lifting a freezer through the house at that time. The heart does not appear to accelerate during other activities. I will organise to review Mr SUPERSTARDJ01 clinically, discussed the result with him as he may require organising permanent pacemaker insertion

Answer: There is a lot of information here to cover. I'll try to explain the main points but if you need more info just ask. Your 24 hour ECG (Holter monitor) results show extreme bradycardia. Bradycardia refers to a slower than normal heartrate. A normal heartrate is about 60-100 bpm at rest. Of course, your heartrate should increase with exercise and it can slow quite a bit when you are sleeping. In your case, your mean (average) heartrate over a 24 hour period is 38 bpm and this is much too slow (extreme bradycardia). The symptoms you describe can be attributed to this condition. You may also feel very fatiqued. Your doctor's interpretation of the recording indicates that he/she saw no atrial activity. The atria are the top chambers of your heart. Normally, a heartbeat originates above the atria and they contract first before the ventricles which are the bottom chambers of your heart. In your case the doctor did not see atrial activity and mentioned that your heart rhythm is probably junctional. This suggests that your heartbeat is originating below the level of the atria, probably at the level of the junction between the top and bottom chambers of your heart. A pacemaker would be the common recommendation for this condition. This is a problem with the electrical conduction of your heart only. The doctors' notes you provided do not indicate any other heart problems, such as blocked arteries. Your cardiologist will discuss the possibility of a pacemaker insertion and should answer all your questions.

Question: Help do i have the right answers? (heart rhythms)? 1. Normal sinus rhythm - all aspects of the cardiac cycle are regular 2. PVC - beat comes early in the cycle, with a wide, bizarre QRS complex 3. Sinus Bradycardia - rate is less than 60. all other aspects normal 4. mobitz 1 - the PRI becomes progressively longer, eventually dropping a QRS complex 5. ventricular fibrillation - ekg tracking is chaotic, without clearly defined cycle components. 6. Asystole - P waves are poorly defined with a wandering isoelectric line. 7. ???????? - the cardiac rate varies with respiratory effort 8. 1st Degree Heart Block - the PRI is greater than .20 seconds 9. Junctional Escape Rhythm - occurs at a rate of 40-60 with P waves absent or in irregular places 10. Atrial Flutter - P waves are sawtooth at a rate of 150 to 250 BPM 11. 3rd Degree Block - atrial and ventricular activity occur independently of each other 12. Sinus Tachycardia - rate of 100 or grater, all other aspects of the cardiac cycle are normal 13. ??????? - occurs at a rate of 250 to 350 BPM: regular wide and bizarre QRS complexes 14. Ventricular tachycardia - starts and stops suddenly, with a rate of 150 to 200 BPM, P waves are lost 15. mobitz 2 - a pattern of 2,3,4 or more P waves between QRS complexes. 16. idioventricular rhythmm - Occurs at a rate of 20 to 40 BPM with wide bizarre QRS complexes its for a test and i just want ot make sure i'm studing the rigth material

Answer: 13 Ventricular tachycardia (V-tach) 14 Supraventricular tachicardia (SVT) 6 Asystole is just a wandering isoelectric line, you usually won't even see P waves. The heart is almost completely inactive Is this for a test or are you learning about CPR/defibrillation?