History:
This ECG was recorded from a 62 year-old man who presented to A&E with coffee ground vomiting. She denies any cardiac symptoms.
ECG shows:
Overall rhythm is irregular, mean ventricular rate 100/min
There are multiple premature atrial contractions (PAC) and premature junctional contractions (PJC), which can be mistaken for wandering atrial pacemaker.
Occasional sinus beats are seen (arrow)
Evidence of PAC:
-abnormal p wave very close to preceding T wave
-distorted T wave (tall and pointed)
-compensatory pause following PAC in early part of the rhythm strip
Evidence of PJC:
-negative p wave before QRS complex
-hidden p wave in QRS complex
Normal axis, Normal PR interval for sinus beat and PAC, Normal QRS duration for sinus beat, PAC and PJC, Prolonged QT in sinus beat
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