An adult with h/o of HTN came in due to mechanical fall. What is your interpretation?
As you can see, there are bigeminal PVC's. QRS complexes 1,3,5,7,9,11 are conducted with prolonged PRI's (0.28 sec). The PRI's of complexes 13 and 14 are shorter (0.16 sec). The P wave after QRS complex # 12 is not conducted.
The possible explanation as shown in the ladder diagram is PVC with concealed retrograde conduction.
The sinus P wave following the interpolated PVC reaches the AV node during it relative refractory period (induced by concealed retrograde conduction of the PVC) and is conducted with prolonged PRI.
Blocked P wave
The P wave (after complex # 12) reached the AV node during its absolute refractory period (induced by concealed retrograde conduction of the PVC) and failed to conduct.
Interpretation: Sinus rhythm, prolonged PRI and non-conducted P wave due to concealed retrograde conduction of PVC's .
* You can read (samples) compiled ECG's in the "ECG Rhythms Flashcards" in the link. If you have time please leave a comment. Thank you.
Fisch C and Knoebel, 2000, Electrocardiography of Clinical Arrhythmias, Futura Publishing Company Inc, NY