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Sinus rhythm with 4 beat run of VT changing to bigeminal PVCs.  The P waves are tall and suggesting right biatrial enlargement. 

The rhythm is irregular due to the bigeminal PVCs.  Upright P waves are present and they are paired with a QRS complex.  

In this strip, the patient is in AIVR or VT and converts to atrial fibrillation with bigeminal PVCs

On this page, the patient is in atrial fibrillation and is having some bigeminal PVCs

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Junctional rhythm with bigeminal PVCs The rhythm is irregular with a rate of 60/min.  No P waves are seen.  There are bigeminal PVCs present.   PR:  ---,  QRS:  .08 sec,  QT:  .44 sec.   Interpretation:   Junctional rhythm with bigeminal PVCs 2. Normal sinus rhythm Wow, this strip looks really dirty.   I apologize.  Something must have changed in the contrast when it was uploaded. The rhythm is regular with a rate of 60/min.  There are P waves associated with each QRS complex.  The P waves are upright and uniform.  There is ST depression and T wave inversion seen in lead II and 1mm ST elevation seen in lead V1.  PR:  .18 sec,  QRS:  .08 sec,  QT:  .36 sec.  Interpretation:  Normal sinus rhythm 3. Normal sinus rhythm with PACs The rhythm is irregular. ...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. 2nd degree AV block type I The rhythm is irregular with a rate of 50/min.   The P waves are upright and uniform.   There is gradual elongation of the PR interval.    There is a nonconducted P wave after the 4th complex.  No ectopic beats are seen.   The QRS complex is narrow.   PR:  .28/.32/.36 sec.  QRS:  .08 sec, QT:  .48 sec.  Interpretation:  2nd degree AV block type I 2. Atrial fibrillation  The rhythm is irregular with a rate of 80/min.   No P waves are seen.  There is an aberrantly conducted complex that arrives later in the cycle after the 4th complex.  There is 3 mm ST elevation in the V1 lead.  PR:  ---,  QRS:  .12 sec,  QT:  .44 sec.   Interpretation:  Atrial fibrillation 3. Atrial paced The rhythm is regular ...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Asystole with AV pacer spikes The underlying rhythm is asystole.   There are atrioventricular pacer spikes present but they are not capturing.   The heart is dead but the pacemaker is still functioning and generating impulses as it was programmed to do.  Usually an internal pacemaker is disabled by placing a magnet over it. 2. Atrial flutter  The rhythm is slightly irregular with a rate of 80/min.  There are flutter waves present between the QRS complexes.   No ectopic beats are seen.   PR:  ---,  QRS:  .12 sec,  QT:  .48 sec. 3. Biventricular paced The rhythm is regular with a rate of 75/min.   P waves are present, upright, and have a corresponding QRS complex.   There are biventricular pacer spikes before each QRS complex. ...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Accelerated junctional rhythm The rhythm is regular with a heart rate of 71/min.   The P waves are absent.   No ectopic beats are noted.   The QRS complex is narrow.   PR:  ---,  QRS:  .08 sec,  QT:  .40 sec. 2. Multifocal atrial tachycardia The rhythm is irregular with ventricular rate of 150/min.    P waves are upright but are not uniform in appearance.   There is also some variability in the PR interval.   No ectopic beats are noted.  PR:  .16 sec,  QRS:  .08 sec,  QT:  .32 sec. 3. Atrial flutter The rhythm is regular with a rate of 71/min.   There flutter waves seen between the QRS complexes.  No ectopic beats are noted.  PR:  ---,  QRS:  .08 sec,  QT:  undetermined. 4. Atrial paced The rhythm is...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Accelerated junctional rhythm The rhythm is regular with a rate of 75/min.   There are retrograde P waves that follow the QRS complexes.   No ectopy is seen.   PR:  ---,  QRS:  .14 sec,  QT:  .44 sec. 2. Atrial fibrillation with bigeminal PVCs The rhythm is irregular.   The rate is 80/min.   The P waves are absent but fibrillation is seen between the QRS complexes.   Unifocal PVCs are seen every other beat.   PR:  ---,  QRS: .10 sec,  QT:  .32 sec. 3. Complete heart block The rhythm is regular with a ventricular rate of 36/min and an atrial rate of 88/min.   The P waves and the QRS complexes are not associated.  The QRS complexes are wide indicating a ventricular escape mechanism.   PR:  ---,  QRS:  .12 sec,  QT:  .60 sec 4. Atrial fibrillat...