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...

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