A 34-year-old nurse complained of recurrent attacks of palpitations in the past 2 months. The palpitations were not related to any specific event or physiological changes. Twenty-four-hour ambulatory electrocardiographic monitoring of her cardiac rhythm using a Holter recorder did not reveal any arrhythmias, even though she reported several attacks of palpitations during the recording. The electrocardiogram (ECG) in Figure 1 was recorded following an emotionally stressful period and when she complained of having palpitations. The patient was alert at the time, and her blood pressure was normal.

1.    e. none of the above

The ECG represents a pseudo-arrhythmia due to artifacts. Two clues direct you to the correct interpretation. The first clue reveals sinus rhythm in lead II. The normal appearance of the complexes in lead II is a result of the cancellation of artifacts and not because of a transient return to normal rhythm. The second clue is that...

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