AF or AFL or Artifact

  1. Here is an example of what? AF or AFL or Artifact. Note QRS complexes clearly defined. Looks to be SR but possible slightly irregularly irregular? Also PACs and PVCs in ECG.

    Thanks for feedback!

    Shutterfly
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  2. 18 Comments

  3. by   traumaRUs
    Moved to nursing student assistance
  4. by   Here.I.Stand
    I see between some of the QRS's definite artifact... right now I'm on my phone and my aging eyes are straining to see if P waves are there or not...the pic is tiny. With afib you won't see them. With a-flutter you see a clear saw-tooth pattern between QRSs, so that one is out
  5. by   Dsmcmm
    Agree on AFL assessment. Does there appear to be any irregularity to rhythm? I see ni P waves.
  6. by   nursej22
    I don't see p or flutter waves. Kinda of weird to see such deep q waves on all leads. Looking at the rate, I might think this is a junctional rhythm.
  7. by   Dsmcmm
    My error. This is single lead event monitor. 32 second continous read . 25mm/sec.
  8. by   Mavrick
    top line: NSR with 1 PVC (5th beat)
    2nd line: NSR with artifact
    3rd line: artifact, NSR, 1 PAC (5th beat)
    bottom line: NSR. Rate approximately 70.

    Rhythm is essentially regular except for PVC and PAC. P waves not that distinct but regular and can be due to electrode position. (More common in 1 lead situation rather than official EKG electrode positioning.)
    Last edit by Mavrick on Nov 22
  9. by   Dsmcmm
    Quote from Mavrick
    top line: NSR with 1 PVC (5th beat)
    2nd line: NSR with artifact
    3rd line: artifact, NSR, 1 PAC (5th beat)
    bottom line: NSR. Rate approximately 70.

    Rhythm is essentially regular except for PVC and PAC. P waves not that distinct but regular and can be due to electrode position. (More common in 1 lead situation rather than official EKG electrode positioning.)

    Thank you.
    Question: Given the QRS complexes have no artifact to them, could these waves be F-waves with (5-1, 6-1 conduction ) resulting in NSR? I cant make out P waves but I trust your read.
  10. by   Mavrick
    What is an "f-wave"? What does the "S" stand for in NSR?

    Which line/complexes do you see "f-waves"?
  11. by   Dsmcmm
    Quote from Mavrick
    What is an "f-wave"? What does the "S" stand for in NSR?

    Which line/complexes do you see "f-waves"?
    Fibrillatory waves ( AFIB) line 2. Fine amplitude. This is my question.
    S is Sinus

    Thanks.
  12. by   Mavrick
    "f-waves" originate at random in the atria at a very rapid rate (200-350/min).The ventricles respond at varying intervals depending on when the cells have repolarized and are ready to accept a new stimuli. That response (heart rate) in irregularly irregular.

    The sinus node is specialized tissue that produces a very strong electrical signal ("p wave") at regular intervals (60-100). Measuring the distance between QRS complexes (ventricular response) is usually pretty regular with slight variation for respiration.

    These are different sources of stimulation. "f waves" don't turn into "p waves"


    "f waves" don't come and go as quickly as artifact does.
  13. by   Dsmcmm
    Paroxysmal AFib. Is a sudden onset and termination from seconds to days according to Cleveland Clinic.
  14. by   chare
    Quote from Dsmcmm
    Thank you.
    Question: Given the QRS complexes have no artifact to them, could these waves be F-waves with (5-1, 6-1 conduction ) resulting in NSR? I cant make out P waves but I trust your read.
    The QRS complexes will not show artifact as such.
    However, if the artifact were of significant amplitude it might cover the QRS, but it won't affect the QRS morphology.
    Quote from Dsmcmm
    Fibrillatory waves ( AFIB) line 2. Fine amplitude. This is my question.
    S is Sinus

    Thanks.
    No, there are no F waves on line 2. This is artifact. If you measure the R-R intervals you will find that they are consistent. If this were a-fib this wouldn't be the case.
    Quote from Dsmcmm
    Paroxysmal AFib. Is a sudden onset and termination from seconds to days according to Cleveland Clinic.
    I'm curious, what exactly do you see in this rhythm that seems to convince you that this is a-fib?

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