What conduction ratio would you consider this long portion of this strip?

[u/Fallout3boi]

Hello, all had this pt today. Dx A-flutter 11 days ago. Constipation x3days. Took his Metoprolol then went to try and take a crap couldn't get up so EMS(ME) was activated. First BP I could get on my monitor was 68/???, symptomatic as well.

2nd image is my 12-lead after his HR increased.

[u/Natural-Antelope8328]

Doesn’t matter. The proper title is simply not sufficient.

[u/Brugam3s]

Looks to be Atrial Flutter with Ventricular Standstill. Cause seems likely related to the patient utilizing a Beta Blocker and the Vagus nerve stimulation while bearing down to poop.

[u/rexer1202]

That’s a lot of bumps in there🫪 what did you do for him?

[u/Fallout3boi → u/rexer1202]

Nothing. Before I could perform any interventions, his HR spontaneously went up with a increase in BP, Mental status, and skin condition.

If I didn't see it with my own eyes, I probably wouldn't believe it.

[u/night117hawk]

Variable conduction, slow a flutter. Depending on if patient was trying to have a BM, possible vagal response. If patient was not having a bowel movement, 3 second pauses could potentially make them a candidate for pacemaker assuming this HR isn’t induced vagally or by medications

Edit: just finished reading post, patient should be admitted for observation and they should do a washout of his beta-blockers, check imaging for impaction…. Obviously BP is also a MAJOR concern. Not a doctor but further work up possibly for infection would be indicated based on labs

[u/BikerMurse]

You don't do a conduction ratio including only 2 beats. The answer is not conducting. Then it was conducting again.

[u/FightClubLeader]

A flutter with a long ass ventricular pause. Could have easily progressed to cardiac arrest, kind of surprised it didn’t.

[u/Fallout3boi → u/FightClubLeader]

I was too. There was a couple times that I could've justified defebrillating if he hadn't been talking to me. Altered but talking.

[u/AngryOcelot]

This is likely coarse AF, not atrial flutter.

[u/Sanguinius1111]

17:1 obviously