50-year-old man complains of palpitations.
Answer & Explanation
The rhythm includes a short burst of narrow-complex tachycardia at 150/minute certainly capable of producing symptoms of palpitations.
Portion of lead II rhythm strip with section of tachycardia
Notice that the 3rd complex of this rhythm strip is a typical PAC with the early P wave slightly altering the T wave of the 2nd complex. What follows is a regular narrow-complex tachycardia at 150/minute with an inverted P-wave preceding each QRS complex. The rate of 150/minute raises the consideration of atrial flutter with 2:1 conduction, but in the lead II rhythm strip there is no indication of flutter waves at a rate of 300/minute. The regular, deeply-inverted P waves in lead II suggest an ectopic rhythm, and thus this short run of tachycardia is an ectopic tachycardia.
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