Scenario: This is an alarm printout (lead V1 and V6) indicating bradycardia for a heart rate of 39 beats per minute in an 80-year-old Chinese man monitored in the transitional care unit. The patient has a history of coronary artery disease and congestive heart failure. Upon assessment, the patient is lying comfortably in bed and his vital signs are stable. Blood pressure is 126/66, pulse is irregular, and respiratory rate is 20 breaths per minute.

Interpretation: Ventricular bigeminy at 80 beats per minute.

In this example, each normal beat is followed by a premature ventricular contraction (PVC) occurring in a bigeminal (every other beat) rhythm. These beats are ventricular because the QRS is wide, bizarre (>0.12 seconds), and positive in V1. The ST-segment depression seen with the PVCs is due to abnormal repolarization and not myocardial ischemia. The morphology of the PVC indicates that the...

You do not currently have access to this content.