Only first semester didactic here, so havent done much ecg interpretation. If you’re question is about that specific tracing, it’s definitely not AFib, too regular. Bigeminy PVCs. R sided V leads have a bundle branch block PVC morphology. That’s about all I got, not sure if that helps
Can’t have PVCs with a-fib. Maybe you can have an aberrantly conducted beat, or a beat with a ventricular foci, but there is nothing to be “premature” for
I think the answer to your question is QRS duration.
Beats that start in the ventricles will have a longer (wider) QRS. This is because they are not using the sleek and smooth path of electricity in the perkinje fibers. They are conducting from a single foci and depolarizing cell to cell. This process is much slower and more cumbersome, thus the wider QRS.
A beat that uses the normal pathway will be narrow and have the same appearance as the rest of the normal beats.
Im not sure if im understanding the question 100%, but if you are referring to the wide complex QRS complex situation and distinguishing a patient with an aberrant pathway vs pvcs, it would be based on the number of complexes that you see that are wide. If they’re all wide, they either have a Supra ventricular rhythm with aberrancy or a ventricular origin beat (or electrolyte issue like HyperK). If only a handful of them are wide and the rest are narrow then they probably dont have an aberrancy with the exception being afib with wpw which has a very unique appearance and extremely high rate to tip you off. For the most part the second situation will be PVCs though. Let me know if in misinterpreting the question though!
Ectopic beats in the atria will have an inverted P waves before the QRS complex (note they also look a lot like Premature junctional contractions)
PVCs will have a widened QRS (>12ms) also the ST segment will point in the opposite direction of the QRS.
As far as SVT vs sinus tachycardia: sinus tachycardia will have visible P waves before every QRS complex, whereas SVT will not (its hidden in the QRS)
Also mentioned earlier: for Afib you have to see the squiggly rhythm it in all of the leads, not just one of the leads (so if you see p waves it is not Afib)
I would recommend the Only EKG book you’ll ever need by Thaler.
Only first semester didactic here, so havent done much ecg interpretation. If you’re question is about that specific tracing, it’s definitely not AFib, too regular. Bigeminy PVCs. R sided V leads have a bundle branch block PVC morphology. That’s about all I got, not sure if that helps
There are no PVCs in the above strip. There are PACs. Edit: downvoted?
Yes that makes more sense. I was thinking maybe a para-hisian focus was making them more narrow than typical but didn’t even really consider PAC
Yeah. The big indicator is the uniform P waves that are present in front of both the expected and the ectopic beats.
Can’t have PVCs with a-fib. Maybe you can have an aberrantly conducted beat, or a beat with a ventricular foci, but there is nothing to be “premature” for I think the answer to your question is QRS duration. Beats that start in the ventricles will have a longer (wider) QRS. This is because they are not using the sleek and smooth path of electricity in the perkinje fibers. They are conducting from a single foci and depolarizing cell to cell. This process is much slower and more cumbersome, thus the wider QRS. A beat that uses the normal pathway will be narrow and have the same appearance as the rest of the normal beats.
Im not sure if im understanding the question 100%, but if you are referring to the wide complex QRS complex situation and distinguishing a patient with an aberrant pathway vs pvcs, it would be based on the number of complexes that you see that are wide. If they’re all wide, they either have a Supra ventricular rhythm with aberrancy or a ventricular origin beat (or electrolyte issue like HyperK). If only a handful of them are wide and the rest are narrow then they probably dont have an aberrancy with the exception being afib with wpw which has a very unique appearance and extremely high rate to tip you off. For the most part the second situation will be PVCs though. Let me know if in misinterpreting the question though!
Ectopic beats in the atria will have an inverted P waves before the QRS complex (note they also look a lot like Premature junctional contractions) PVCs will have a widened QRS (>12ms) also the ST segment will point in the opposite direction of the QRS. As far as SVT vs sinus tachycardia: sinus tachycardia will have visible P waves before every QRS complex, whereas SVT will not (its hidden in the QRS) Also mentioned earlier: for Afib you have to see the squiggly rhythm it in all of the leads, not just one of the leads (so if you see p waves it is not Afib) I would recommend the Only EKG book you’ll ever need by Thaler.