I’m posting this here today because I really don’t know the answer to the question and I wanted to get some opinions from the couple of you who still read this blog.
A patient in his 70′s comes in by ambulance with a complaint of dizziness. As part of his workup, we get an EKG which is noted below. I wasn’t able to figure out the rhythm. A cardiologist came down to the ED to evaluate the patient and wasn’t able to tell me what the rhythm was, either. He only stated that it “isn’t malignant” and it “isn’t what’s causing the patient’s dizziness.”
There is a P wave before every other QRS. The PR interval appears to be constant on those beats.
The R to R intervals appear to alternate and are regularly irregular.
The QRS morphology is narrow and seems to be constant, so it doesn’t appear to be bigeminy.
I guessed that it was a Mobitz II. The cardiologist said “no way.”
Your opinions? If you want to get a better look at the EKG, you can click on the picture. Also, a link to a .pdf copy of the EKG is here.