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Incidental Beat

“BRADY” DOWN FOR THE REST

History:

A 42-year-old female with a history of anxiety but no cardiac or other psychiatric history is brought to the ED for hallucinations and agitation due to concerns people are trying to kill her.  She denies any pain, palpitations, or other complaints

Exam:

Vital signs are normal.   Exam is otherwise normal.  A screening EKG was done and is shown below

Initial differential diagnosis:

  • PVC
  • PAC
  • Artifact
  • Fusion beat
  • Electrolyte abnormality
  • Tricyclic overdose

Initial EKG (click TWICE if you want to enlarge):

COMPUTER EKG READ:

  1. Sinus rhythm with fusion complexes.
  2. Otherwise normal ECG

Do you agree with the computer?

“BRADY” DOWN FOR THE EKG ANALYSIS & 1-MINUTE CONSULT

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EKG ANALYSIS, CASE CONCLUSION & 1-MINUTE CONSULT: Peer Reviewed by Dr. Stephen W. Smith of Dr. Smith’s ECG Blog

  • EKG Analysis: The computer read is likely correct.  The final beat of the 12 lead appears to be a fusion beat, with a P-wave and a wide QRS different from the intrinsic rhythm.  In order to be certain it was a fusion beat and not a PVC, you would need to see a PVC to compare it to.
  • Case Conclusion: Patient did well
  • 1-minute Consult: See highlighted area of sample page below and Case Lessons below that.

1-Minute Consult on the EKG topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

Source: The Emergency Medicine 1-Minute Consult Pocketbook   

Case Lessons

  1. Fusion beats are usually incidental and benign
  2. They are usually a fusion of a PVC with a supraventricular beat.

Peer Review:  by Dr. Stephen W. Smith of Dr. Smith’s ECG Blog

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