Double Coupling of VEB Couplets
Report:
Sinus arrhythmia 85 â 109/min
Frequent VEBs
Accelerated idioventricular rhythm (AIVR) approx. 65/min
Comment:
The VEBs come in two morphologies, the tall and the stubby, in the L2 rhythm strip. The tall ones are premature, with a fixed coupling interval of 0.36â to both sinus beats and the stubby VEBs. The short ones are late, with a long coupling or, rather, escape interval of 0.64â. They are almost certainly an expression of an underlying accelerated idioventricular rhythm, kept suppressed by the faster prevailing rhythm.
The trace is bereft of sinus beats in the left precordial leads, but the rest of looks normal apart from the VEBs. It would be reasonable to check the ladyâs electrolytes and also to take another ECG to see the sinus rhythm in V4-6. Then it would be wise to reassure her and do nothing.
189. 56 year old man with COAD and severe angina pectoris.
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