Dawn's picture

This rhythm strip offers two leads taken at the same time, Lead II and Lead V1.  The Lead II strip may not look "typical" to a beginning student, because the sinus beats are very small and biphasic.  This is due to an axis shift, which cannot be evaluated without more leads.

One of the best teaching opportunities in this strip is the concept of "underlying rhythm" with ectopy.  The underlying rhythm here is sinus.  But there are sinus P waves which are hidden, making the sinus rate twice what it appears to be.  The P waves are invisible in the Lead II strip, with baseline artifact making them even harder to see.  But in V1, we are able to find them at the end of the PVCs' T waves.  The sinus rhythm is a bit irregular toward the end of the strip.  There are probably many things a more advanced practitioner could say about this strip, but it usually requires more than one or two leads to do a complete evaluation.  For your basic student, it is a good example of sinus rhythm with ventricular bigeminy.

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