Scenario: This is a telemetry rhythm strip (lead II and V1) from an 88-year-old sleeping woman who is being monitored on a medical surgical unit after falling at home without injury. She is being considered for discharge home. The patient has no significant medical history and is asymptomatic to the rhythm below. Do you think further evaluation is needed before hospital discharge?

Normal sinus rhythm at 90 beats/min with premature atrial contractions (beats 4 and 10), a premature ventricular contraction (PVC) (beat 5), followed by a compensatory pause, then one normal sinus beat (beat 6), followed by a unifocal ventricular couplet (beats 7 and 8) originating from the right ventricle, which is also followed by a compensatory pause.

The most dominant rhythm (the underlying rhythm) is sinus. However, in addition to premature atrial contractions, there are 2 episodes of PVCs...

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