Tasty Morsels of EM 031 – Retrograde p waves

I keep a little, ever-expanding note on my phone where I jot down little morsels of goodness that I pick up while listening to or reading one of the many excellent sites/podcasts in the useful resource section. They’re useful in a kind of “board review” way. I tend to skip the really basic stuff and try and focus on what I didn’t know.

I’ll try and transfer them here for your enlightenment.

From K Wang on HQMEDED

The basics on retrograde p waves

  • a junctional beat is one occurring from the AV node

  • normally narrow with no preceding p wave

  • the impulse travels down from av node causing the narrow complex qrs

  • an impulse also goes up from the av node and depending on whether the atrium is refractory or not will result in a retrograde (usually inverted p wave)

Example here from LITFL of an accelerated junctional rhythm with retrograde p waves(inverted p waves in II, III and aVF)

Accelerated Junctional Rhythm

About Andy Neill

EM Reg/Resident based near Dublin. Former anatomy lecturer, theology student and occasional musician @andyneill | + Andy Neill | Contact

Comments

  1. Carlos Crespo, M.D. says:

    Hello Andy, I had sent you a mail before regarding the Anatomy for E.M. cast you use to produce, they were excellent.
    I just want to let you know that a lot of my students and residents in EM and Pediatrics in the School of Medicine of Monterrey Mexico, are looking at your casts and they enjoy them.
    Congratulations for this new project.
    Regards
    Carlos F. Crespo, MD

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