ECG Guru - Instructor Resources - Atrial bigeminy https://www.ecgguru.com/ecg/atrial-bigeminy en Bigeminal Rhythm With Aberrant Conduction https://www.ecgguru.com/ecg/bigeminal-rhythm-aberrant-conduction <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/bigeminal-rhythm-aberrant-conduction"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/NSR%20PACs%20Aberr.jpg" width="1800" height="1341" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal">This ECG is a good example of sinus rhythm with aberrantly-conducted PACs.&nbsp; The tracing was donated to the ECG Guru several years ago by Dr. Ahmed from Sanjiban Hospital in India.&nbsp; We have no patient data for this tracing.<span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal">The underlying rhythm here is normal sinus rhythm. Most of the parameters – rate, PR interval, and QRS duration – are normal.&nbsp; The QTc interval, which is the QT interval corrected to a rate of 60 bpm, is prolonged at 568 ms.&nbsp; We do not know the patient’s clinical condition or medications, so we cannot guess at the reason.&nbsp; However, a prolonged QTc is associated with an increased risk of <span style="color: red;"><a href="http://lifeinthefastlane.com/ecg-library/tdp/">Torsades de pointes,</a></span> a type of polymorphic ventricular tachycardia.<span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal">The first three beats appear the same (Leads I, II, and III).&nbsp; However, the first R-to-R interval is shorter than the second one.&nbsp; This could be due to rate variation, a concealed sinus block, or a premature atrial contraction (PAC). &nbsp;&nbsp;The P wave of the “early” beat, marked #1, looks slightly different from the other P waves in Lead II, but, because of the slow rate, there is no way to be sure without a longer rhythm strip.&nbsp; After the possible PAC, the rhythm becomes coupled, probably <span style="color: red;"><a href="http://ecgguru.com/ecg/sinus-rhythm-atrial-bigeminy">atrial bigeminy,</a> </span>where every other beat is a PAC.&nbsp; There are several mechanisms that cause grouped beating, but atrial ectopic bigeminy is the most common. Normally, PACs have different-looking P waves compared to the sinus beats. &nbsp;In this ECG, the P waves are often buried in the preceding T waves, and are hard to evaluate.<span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">Interestingly, the PACs in this strip are conducted with varying amounts of <span style="color: #c00000;"><a href="http://www.metealpaslan.com/ecg/aberasyonen.htm">aberrancy</a>.&nbsp; </span>Because they are premature, they find the ventricles in varying stages of repolarization.&nbsp; When the ventricles are not completely repolarized, the electrical impulse may conduct down the more recovered conduction pathways, while going around the less recovered pathways.&nbsp; A common form of aberrant conduction is <span style="color: #c00000;"><a href="http://ecgguru.com/ecg/instructors-collection-ecg-week-september-23-2015-right-bundle-branch-block-0">right bundle branch block</a></span>.&nbsp; In RBBB aberrant conduction, the impulse finds the right bundle branch temporarily unable to conduct, so it follows the left bundle branch down into the ventricles.&nbsp; The left ventricle is depolarlized slightly ahead of the right, and the common ECG pattern of a wide QRS with rSR’ pattern in V1 and Rs in Leads I and V6 will appear.</span><span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">The PAC marked “2” probably has a small degree of aberrancy.&nbsp; The PACs marked “3” and “4” appear almost like the normal beats.&nbsp; PACs “5” and “6” have clearly taken on the form of right bundle branch block, including the T wave changes commonly seen with RBBB.</span><span style="font-size: 8pt; line-height: 107%;">&nbsp;</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">The clinical significance of the grouped beating, and of the prolonged QT interval, would have to be evaluated before treatment is decided.&nbsp; But, this ECG provides students with a good opportunity to see variations on aberrant conduction.</span></p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/588/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Bigeminal Rhythm With Aberrant Conduction 1/5</option><option value="40">Give Bigeminal Rhythm With Aberrant Conduction 2/5</option><option value="60">Give Bigeminal Rhythm With Aberrant Conduction 3/5</option><option value="80" selected="selected">Give Bigeminal Rhythm With Aberrant Conduction 4/5</option><option value="100">Give Bigeminal Rhythm With Aberrant Conduction 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.5</span></span> <span class="total-votes">(<span >8</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-ZkWXlYJXbnQobNDlhW8fivcqteqgR8Pfgartrvh4HYE" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/right-bundle-branch-block-1" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Right bundle branch block</a></div><div class="field-item odd"><a href="/ecg/aberrant-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Aberrant conduction</a></div><div class="field-item even"><a href="/ecg/long-qt-interval" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Long QT interval</a></div><div class="field-item odd"><a href="/ecg/pac" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">PAC</a></div><div class="field-item even"><a href="/ecg/atrial-bigeminy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial bigeminy</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fbigeminal-rhythm-aberrant-conduction&amp;title=Bigeminal%20Rhythm%20With%20Aberrant%20Conduction"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Thu, 25 Feb 2016 02:09:38 +0000 Dawn 688 at https://www.ecgguru.com https://www.ecgguru.com/ecg/bigeminal-rhythm-aberrant-conduction#comments Atrial Bigeminy Vs Possible Sino-atrial Exit Block https://www.ecgguru.com/ecg/instructors-collection-ecg-week-october-5-2015-sino-atrial-exit-block-0 <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/instructors-collection-ecg-week-october-5-2015-sino-atrial-exit-block-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/MR%20115%202ndDeg%20SA%20block%20Type%20II_0.jpg" width="3278" height="2289" alt="" /></a></div><div class="field-item odd"><a href="/ecg/instructors-collection-ecg-week-october-5-2015-sino-atrial-exit-block-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/MR%20115%20Laddergram%20jpg.jpg" width="3507" height="2550" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal" align="left">This three-lead rhythm strip is from an 85 year-old-woman for whom we have no other information, unfortunately.&nbsp; It shows an obvious, regular bigeminal pattern.&nbsp; There are many rhythms that can cause bigeminy, with regular, paired beats.&nbsp; So, how do we analyze this rhythm?<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal" align="left">First, we can see that all the QRS complexes are fairly narrow and look alike in each lead.&nbsp; So, we know this is a supraventricular rhythm.&nbsp; The rhythm “marches out”, with the same spacing between all the paired beats, and exactly one P-QRS missing after each pair.<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal" align="left">Sino-atrial exit block occurs when the sinus node fires, but the impulse is unable to exit the sinus node. No P wave will occur, but the sinus node continues to fire in a regular rhythm.&nbsp; There are four types of SA block, just as there are four types of AV block.&nbsp; <strong>This ECG meets the criteria for a Second-degree, Type II SA block.</strong><strong style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</strong></p><p class="MsoNormal" align="left"><strong>First-degree SA block</strong> would not be decipherable on the ECG, as we do not see the SA node fire, and therefore cannot measure an interval between the SA node firing and the production of a P wave.<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal" align="left"><strong>Second-degree SA block, Type I</strong> would have progressively prolonging exit times for the impulse leaving the SA node. &nbsp;<span style="font-size: 13.008px; line-height: 1.538em;">This would produce </span><strong style="font-size: 13.008px; line-height: 1.538em;">progressively shortening R-to-R intervals</strong><span style="font-size: 13.008px; line-height: 1.538em;">, until the pause.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal" align="left"><strong>Second-degree SA block, Type II</strong> has <strong>regular R-to-R intervals until the pause</strong>, and the pause will equal two or more (usually two) R-to-R intervals.&nbsp;</p><p class="MsoNormal" align="left"><strong style="font-size: 13.008px; line-height: 1.538em;">Third-degree SA block</strong><span style="font-size: 13.008px; line-height: 1.538em;"> produces NO P WAVES, and would have to be diagnosed on electrophysiology studies, as it would usually result in a junctional escape rhythm.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal" align="left">Differential diagnosis includes many causes of “atrial bigeminy”.&nbsp; When every other beat is a premature atrial contraction (APB or PAC), the pause will be caused by the PAC “re-setting” the sinus node, and will not be a multiple of the R-to-R interval on that strip.&nbsp; We can differentiate this rhythm from the AV blocks because in sinus block, the P wave is missing.&nbsp; In AV block, the P wave is present, but not always conducted.<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal" align="left">To better illustrate what may be happening in this ECG, we have included a laddergram.&nbsp; If you are not familiar with using laddergrams, please refer to the following links.<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal" align="left">ECG Guru, <a title="Guru Laddergrams Blog" href="http://ecgguru.com/ecg/laddergram">Are You New To Laddergrams</a>,&nbsp;&nbsp; Dr. Ken Grauer, <a title="Grauer Making Laddergrams" href="http://ecg-interpretation.blogspot.com/2013/06/ecg-interpretation-review-69-pvc-pjc.html">Making A Laddergram</a>.<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal" align="left">Clinically, we would want to investigate the possible cause of the SA block or atrial bigeminy, and watch for worsening of any block, which could result in a dangerous bradycardia.</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/588/feed" method="post" id="fivestar-custom-widget--2" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--4" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Atrial Bigeminy Vs Possible Sino-atrial Exit Block 1/5</option><option value="40">Give Atrial Bigeminy Vs Possible Sino-atrial Exit Block 2/5</option><option value="60">Give Atrial Bigeminy Vs Possible Sino-atrial Exit Block 3/5</option><option value="80" selected="selected">Give Atrial Bigeminy Vs Possible Sino-atrial Exit Block 4/5</option><option value="100">Give Atrial Bigeminy Vs Possible Sino-atrial Exit Block 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.5</span></span> <span class="total-votes">(<span >2</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--2" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-QVCpbukEUTHfGBBB0U8bJyTySe4yrUNRn41IyTVSnSA" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/sino-atrial-exit-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Sino-atrial exit block</a></div><div class="field-item odd"><a href="/ecg/sa-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">SA block</a></div><div class="field-item even"><a href="/ecg/sa-block-type-ii" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">SA block Type II</a></div><div class="field-item odd"><a href="/ecg/bigeminy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Bigeminy</a></div><div class="field-item even"><a href="/ecg/atrial-bigeminy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial bigeminy</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_2"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Finstructors-collection-ecg-week-october-5-2015-sino-atrial-exit-block-0&amp;title=Atrial%20Bigeminy%20Vs%20Possible%20Sino-atrial%20Exit%20Block"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Mon, 05 Oct 2015 23:26:34 +0000 Dawn 670 at https://www.ecgguru.com https://www.ecgguru.com/ecg/instructors-collection-ecg-week-october-5-2015-sino-atrial-exit-block-0#comments Sinus Rhythm With Atrial Bigeminy https://www.ecgguru.com/ecg/sinus-rhythm-atrial-bigeminy <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/sinus-rhythm-atrial-bigeminy"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/MR116.jpg" width="1828" height="1436" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This ECG is from an 88-year-old man with congestive heart failure. &nbsp;No other clinical information is known. &nbsp;It shows an underlying sinus rhythm with atrial bigeminy - every other beat is a premature atrial contraction. &nbsp;There is very little, if any, difference in the morphology of the sinus P waves and the ectopic P waves, indicating that the ectopic focus is in the vicinity of the sinus node. &nbsp;There is no "compensatory" pause, because PACs penetrate the sinus node, resetting it. &nbsp;So, the underlying sinus rate here is about 72 beats per minute. &nbsp;There are several mechanisms for bigeminy to occur, but ectopic bigeminy is the most common.</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/588/feed" method="post" id="fivestar-custom-widget--3" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--6" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Sinus Rhythm With Atrial Bigeminy 1/5</option><option value="40">Give Sinus Rhythm With Atrial Bigeminy 2/5</option><option value="60">Give Sinus Rhythm With Atrial Bigeminy 3/5</option><option value="80">Give Sinus Rhythm With Atrial Bigeminy 4/5</option><option value="100" selected="selected">Give Sinus Rhythm With Atrial Bigeminy 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.5</span></span> <span class="total-votes">(<span >4</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--3" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-dBSSHFew1a2PCkRKnkdxYZphyh4ECSBKJhE3zkJb-Ns" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/atrial-bigeminy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial bigeminy</a></div><div class="field-item odd"><a href="/ecg/premature-atrial-contraction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Premature atrial contraction</a></div><div class="field-item even"><a href="/ecg/bigeminy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Bigeminy</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_3"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fsinus-rhythm-atrial-bigeminy&amp;title=Sinus%20Rhythm%20With%20Atrial%20Bigeminy"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Tue, 07 Jul 2015 21:56:59 +0000 Dawn 650 at https://www.ecgguru.com https://www.ecgguru.com/ecg/sinus-rhythm-atrial-bigeminy#comments ECG Basics: Sinus Rhythm With Atrial Bigeminy https://www.ecgguru.com/ecg/ecg-basics-sinus-rhythm-atrial-bigeminy <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/ecg-basics-sinus-rhythm-atrial-bigeminy"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/107%20Sinus%20Rhythm%20with%20Atrial%20Bigeminy.jpg" width="1800" height="295" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This is a normal sinus rhythm with atrial bigeminy, a term meaning that every other beat is a PAC. &nbsp;If you look carefully, you can see slight differences in the sinus P waves and the atrial (premature) P waves. &nbsp;The PACs penetrate and reset the sinus node, causing what looks like a delay after the PAC. &nbsp;It is often just a return to the normal P to P interval, or nearly so. &nbsp;If you teach basic students in a clinical setting, they will learn from palpating the peripheral pulse and feeling the pattern of bigeminal beats. Sometimes, the premature beat feels much weaker due to less filling time available to the ventricles. &nbsp;Atrial bigeminy can have very benign causes, such as increased caffeine intake, or it can have more complex causes such as advanced heart disease or conduction blocks. &nbsp;In some patients, atrial bigeminy, or any PACs, can be a precursor to more serious atrial dysrhythmias, such as atrial fibrillation.</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/588/feed" method="post" id="fivestar-custom-widget--4" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--8" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give ECG Basics: Sinus Rhythm With Atrial Bigeminy 1/5</option><option value="40">Give ECG Basics: Sinus Rhythm With Atrial Bigeminy 2/5</option><option value="60">Give ECG Basics: Sinus Rhythm With Atrial Bigeminy 3/5</option><option value="80" selected="selected">Give ECG Basics: Sinus Rhythm With Atrial Bigeminy 4/5</option><option value="100">Give ECG Basics: Sinus Rhythm With Atrial Bigeminy 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.4</span></span> <span class="total-votes">(<span >8</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--4" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-5cWZxnxXRy_D_aP-i_QaZwdYMB3qJuQ3tKtPxb8WUks" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/ecg-basics" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ECG Basics</a></div><div class="field-item odd"><a href="/ecg/basic-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Basic ECG</a></div><div class="field-item even"><a href="/ecg/rhythm-strip" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Rhythm strip</a></div><div class="field-item odd"><a href="/ecg/sinus-rhythm" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Sinus rhythm</a></div><div class="field-item even"><a href="/ecg/atrial-bigeminy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial bigeminy</a></div><div class="field-item odd"><a href="/ecg/pacs" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">PACs</a></div><div class="field-item even"><a href="/ecg/premature-atrial-contractions" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Premature atrial contractions</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_4"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fecg-basics-sinus-rhythm-atrial-bigeminy&amp;title=ECG%20Basics%3A%20%20Sinus%20Rhythm%20With%20Atrial%20Bigeminy"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 30 Jun 2013 07:22:29 +0000 Dawn 459 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-sinus-rhythm-atrial-bigeminy#comments