sinus rhythm with artifact
First Glance:
From across the room it looks like sinus with two bursts of wide complex tachycardia.
Discussion:
This should now be mundane. From across the room you should think “artifact”. The definitive finding is the stable regular arterial tracing below. A Sp02 trace would prove the same.
If we only had the EKG strip, the first burst looks something like ventricular flutter (it’s fast- about 300 bpm) or fast VT. The second burst is slower at about 130 bpm, and might smack of VT. However we can clearly see the narrow regular QRS complexes marching through, superimposed over the artifact.
Final Impression?
NSR @ ~95 bpm.
Management implications:
95 bpm is technically not a tachycardia in the books, but it should raise eyebrows. Many clinicians use a HR of 90 as suggestive of some kind of abnormal process.
The Take-home Point:
The more artifact you see, the better you should get at recognizing artifact. Strips with ‘paroxysmal’ artifact are nice for comparing against the native rhythm and learning how to differentiate the two.
Two star strip. The meat and potatoes.