EKG of the Week

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This EKG was done on asymptomatic patient, noted to have slow peripheral pulse but fast heart rate! 

+ EKG Interpretation

Dr. Ohlbaum's Explanation

I think the easiest place to work through a tricky rhythm is in the rhythm strip leads -you get a longer stretch to look and those leads chosen because the P waves easiest to see. In this EKG I am going to look at the long lead II in the rhythm strip. Looking at that as a whole, there are some narrow beats that follow P waves, and some wide, funny looking beats that do not have P waves.

So, the first beat on the tracing is wide and funny looking. I do not know what comes before it but it looks like a PVC. There is then a P wave and a narrow QRS which looks like a sinus beat and there are then 3 of the wide QRS complexes, then another sinus beat, and another 5 wide QRS complexes. Then 2 more sinus beats and a PVC, another sinus and another PVC.

What do we call these episodes of 3 or 5 PVC in a row? Nonsustained Ventricular Tachycardia.

There are so few sinus beats it is difficult to read much about the QRS or ST and T but I think the Tis inverted in lateral leads, so possible lateral ischemia, but this could also be related to the frequent ectopy.

This is sinus rhythm with frequent PVC and 3-5 beat runs of nonsustained ventricular tachycardia.

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