Name the rhythm

[scott33]

Ignoring the first half complex...

Complex 1, 2, and 3 are equal in duration.

The distance between complex 4, and 5 is the same as between 2, and 4

Complexes 5, 6, and 7 are equal in duration, but longer than complexes 1, 2, and 3

Can't see any pattern to complexes 8, 9, 10, 11, or 12

No discernable p-waves (anything which may be assumed to be P-waves are not repeated subsequently in a similar morphology) narrow QRS, and irregular rhythm which possibly, just possibly, has a degree of repitition to it, though no apparent predictable trends are noticeable. Otherwise, irregularly irregular.

A-fib till proven otherwise

[spenac]

The rule I think has been the hardest for me to accept is basically that any irregular rythm with no p-waves and basically normal QRS is afib. Until I caved in I missed similiar EKG's on multiple exams. Definitly try to get a longer strip and eliminate artifact if possible, but for exam purposes most books etc I have seen will call similiar afib. Sorry not more help.

[akroeze]

But the definition of a-fib is irreg irreg with absent p waves isn't it? This is absent p waves with reg irreg

[Arizonaffcep]

What's that saying, that if you show a strip to 5 different cardiologists, you'll get 6 different answers... :mrgreen:

Added: My first inclination was to call it A-fib...but it is regularly irregular. Maybe controlled? My guess would be maybe some a-fib/flutter with a block of some sort. If you look between the first 1/2 beat and the first full one, there are 3 little bumps that could be flutter waves? It occurs again between beats 4 and 5, but then there are 5 bumps. [s:5230eb3d5a]Maybe the Pt's pleasure... :shock[/s:5230eb3d5a]: HPV?

[akroeze]

I think the idea of flutter with fib as well is probably the best option with the given strip.

I think the moral of the story is that this isn't the best example of a-fib to put in an "introduction to rhythm interpretation" booklet.

[Barefootedkiwi]

I agree with everyone else: A-Fib ... what's the pt's PMH? and meds? Sometimes those two help with "ambiguous" strips.

[crotchitymedic1986]

Thats the beauty of AFIB, if you stare at it long enough, you can see every other rhythm, premature beat, and escape beat none to man. It is simple AFIB, not flutter/fib.

[Niftymedi911]

A-fb with flutter

[mobey]

I would also suspect A-Fib, in the absence of a 12 lead I would crank up the size (gain) to see if I can spot any p waves within the suspected artifact.

[firedoc5]

Irregular, no P waves...AF. I agree with turning up the gain in case P waves could be hidden, but sort of doubt it.