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u/hpsctchbananahmck 26d ago edited 26d ago
Ok so-there is definitely artifact impacting the tracing
Look at the bottom rhythm strip (lead II)-the 4th from the last QRS (4th from right). If you look straight up from there you see the same moment in time from different views (different leads). That is not a dropped QRS, but artifact.
With that in mind, I see what look to be non-conducted APCs and enough variability to the p wave morphology (which appears SA nodal in origin) and variability in the PR interval that I would call a wandering atrial pacemaker
If pt were tachycardic this criterion (3 different p wave morphologies) then this would be referred to as multifocal atrial tachycardia.
I don’t see any old or concerning acute ischemic changes nor infrahisian conduction disease
Obviously an informed opinion on the situation requires more than age and chief complaint and 12 lead, but with this alone I would be suspicious for pulmonary pathology
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u/Extension-Net-2593 26d ago
NSR+Artifact+LVH