sinus rhythm
First Glance:
From across the room it looks like sinus with a run of polymorphic VT
Discussion:
There is a lot of baseline artifact, but the operator has gained up our lead II significantly to show spiky unmistakable P waves before the QRS complexes. Then there is a burst of bizarre stuff that could be polymorphic ventricular tachycardia, or torsades.
So is it VT, or is it artifact? We don’t have another lead here to corroborate, which would help.
Look here:
See those spiky QRS’s tracking through this burst of whatever? That means its artifact, because there is no way the ventricles could be racing away at 300 bpm while allowing the native rate to track through on top of it.
Final Impression?
Sinus rhythm @ ~85 bpm.
Management implications:
Nothing, really. Just don’t shock them.
The Take-home Point:
This artifact was caused by some unknown cyclic artifact. Sometimes we can take some useful clinical information from a tremor artifact.
Shivering tremor is often on the fast side, around 8-11Hz. Parkinsonian tremor is on the slow side, generally 3-6 Hz. Essential tremor, and most of the toxicity/withdrawal tremors are more variable, running 4-12 Hz or so.
Hz, or ‘Hertz’ is a frequency unit that shows cycles per second. 6 Hz is 6 cycles per second. To make a quick conversion between EKG and cycles per second, you can count artifact cycles in 5 large boxs ( 5 x 200ms).
Two star strip. The meat and potatoes.