Ok folks I'm stumped. I monitored a pt who I'd have liked to have in my unit, not on the floor on tele, and who had a rythym I've never seen the likes of before. I'll describe it, and y'all tell me if you've seen this. Occasionally she's sinus, PRI of .15 or .16, brady in 50s with a right bundle block, no big deal. Then there's a pause, sometimes 1 sec, sometimes long enough to make the monitor go nuts, then we get paired beats. The pairs are such that the first one in the pair has a PRI of about .16 and it looks just like the sinus beats did. The second one in the pair is a pvc. It should just be bigeminy but the pvc's vary in size, still unifocal, and some of them look like little escape beats. The distance between the pairs is fairly consistent, but longer than I would like for a compensatory pause to be. I'm used to bigeminy looking like almost equal distance between most of the beats, it doesn't bunch up into pairs.
I ran a deskfull of strips on this lady, got my eyeballs to vibrating eventually and I am convinced this is 3rd degree block with the p waves hidden in the T after each pvc. It just takes being either really picky or truly hallucinating to find 'em. I can't decide which I was doing. I did try looking this stuff up, I can't find examples of anything that looks like this.
And the troponin was up, there was a little ST elevation, maybe 1 mm.