McGill Case 238

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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.

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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.