Scenario: This rhythm strip was obtained in a 51-year-old man admitted to the intensive care unit (ICU) 3 days earlier with a grade IV right frontal intraparenchymal subaracÚoid hemorrhage. The patient had a history of hypertension, multiyear illicit drug use and smoking (½ pack of cigarettes a day). His vital signs were unchanged during the rhythm. The patient’s symptoms could not be determined because he was receiving mechanical ventilation and was sedated. The rhythm strip shows leads I, II, III, V1, and aVR as well as his arterial waveform.

Accelerated idioventricular rhythm (AIVR) for the first 6 beats at a rate of 60 beats per minute. Normal sinus rhythm for last 4 beats at a rate of 75 beats per minute. Lengthened QTc interval.

Ventricular rhythms are generated from pacemaker cells located at the distal end of the cardiac conduction system, which explains the presence of wide...

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