2 EKG strip questions

DebblesRN, ASN, BSN, RN · Jun 28, 2013

That's a good question. I was also not sure it was a PAC since the P waves are absent and the T wave is mostly normal looking. That's why I was suggesting in a previous post that it could also be a PJC. Keep in mind also, it could be difficult to tell if these are PJCs vs PACs due to lead placement. That is why I said this could be diagnosed better by switching chest leads or by a 12 lead. It could be a PAC or a PJC.

The OP came back and posted that the first strip was SR with PACs.

A PJC can have an upside down P wave, a buried P wave, or no P wave at all, so that is why I was not sure which it was.

PJC: Premature Junctional Contractions - Cardiac RhythmÂ Interpretation Review

MunoRN, RN · Jun 28, 2013

A good way to check if a rhythm is what you think it is, is to ask how would it be different if it another rhythm or ectopy, so in strip 1, how would it look different if it were PJC's?

LaceyRN12 · Jun 30, 2013

1st strip:

In a PJC, the P wave is inverted or is after a QRS interval. And the QRS is narrow (as compared to IVRs). There are P waves in this strip, so it is a PAC.

You might think it's a heart block, but if you see the pattern, you'll realize it's not a heart block. PR interval is getting longer and longer, QRS is dropped. PR interval is getting longer and longer, QRS is dropped. PR is... by itself and the QRS is already dropped. So it doesn't make sense. Therefore, the premature beats (if you look at the whole picture) are PACs.

2nd strip:

Just FYI, it is paroxysmal atrial tachycardia because of the beat "jumping in/jumping out" and going back to the regular rhythm. It can technically also be called an SVT. The possibilities of an SVT are atrial tachycardia, junctional tachycardia, atrial fibrillation, and atrial flutter.

MunoRN, RN · Jun 30, 2013

1st strip:
In a PJC, the P wave is inverted or is after a QRS interval. And the QRS is narrow (as compared to IVRs). There are P waves in this strip, so it is a PAC.

There are actually no P waves prior to the premature beats in this strip, so it's not possible to say it's a PAC. In PJC's the P wave might be after the QRS, inverted, or indiscernible.

2nd strip:
Just FYI, it is paroxysmal atrial tachycardia because of the beat "jumping in/jumping out" and going back to the regular rhythm. It can technically also be called an SVT. The possibilities of an SVT are atrial tachycardia, junctional tachycardia, atrial fibrillation, and atrial flutter.

PAT is a bit of an outdated term when used synonymously with SVT. SupraVentricular Tachycardia refers to a tachycardia that originates above the Ventricles which is why the two terms are often used interchangeably; while the atria are above the ventricles, the problem is this term is often used to describe rhythms could also be a junctional tachycardia or some types of reentry tachycardias which do not originate in the atria but rather at the SA node, which is why SVT is preferred, and yes, "paroxysmal" refers to any intermittent rhythm.