Today's ECG CHALLENGE offers a two-lead rhythm strip and a 12-lead ECG from an 87 year old man with a complaint of shortness of breath. We do not know any other clinical information. What is the underlying rhythm? How can we explain the changing QRS morphology? There are two distinctly different QRS complexes - one wide and one narrow. Comment below and let us know what you think. We will answer your questions as soon as we can, and will give a final diagnosis in one week.
This series of strips was donated by Arnel Carmona, and was taken from a patient admitted to the hospital for a urinary tract infection. No other history is known. On close examination of this rhythm what do we see?
Strip 1: Narrow-complex tachycardia with NO apparent P waves.
Strip 2: Some irregularity, with long regular groups and still NO P waves.
This very interesting set of strips was donated to the ECG Guru by Arnel Carmona, well-known to many of you as the Administrator of the blog, "ECG Rhythms" and the FB page by the same name. He is a frequent contributer to the FB page, "EKG Club", and is an ECG Guru! This set of strips was previously posted to his blog and to the EKG Club.
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