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This case report is kindly provided by Michael Rosengarten from McGill and is part of the McGill Cases. These cases come from the McGill EKG World Encyclopedia.
The cardiogram shows an irregular supraventricular rhythm. Of note are the different p wave morphologies. In the lead II rhythm strip at least 3 different morphologies can be seen. If the average rate was above 100/min this could be called a multi-focal atrial tachycardia, as this recording shows a slower rate it could be called sinus rhythm with frequent PACS. The fact that the p waves all seem to be positive in the inferior leads may suggest they are coming from the sinus node and that this could be a variation of a wandering atrial pacemaker.
