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Sinus rhythm with multifocal PVCs on an ECG strip

PVCs of two or more different shapes.

What to look for

PVCs of more than one shape, coming from two or more ventricular foci. On this strip, one focus gives a tall broad complex in II and the other a deep negative one, each with its own coupling interval. A compensatory pause follows each one.

Examples

Each strip is 6 seconds of lead II, drawn to scale (25 mm a second, 10 mm a millivolt), so you can count boxes the way you would on paper. Each one is a different example, measured below it.

Example 1 · lead II · 6 seconds
II25 mm/s · 10 mm/mV
Rate
86/min underlyingThe whole strip averages 86/min · 9 QRS complexes in 6 seconds × 10 = 90/min
Rhythm
Regular underneath, with early beats breaking it
P waves
Upright in II, uniform
P to QRS
1:1 for the sinus beats; the PVCs have no P wave
PR
0.14 s
QRS
0.07 s, narrow
PVCs
2 on this strip
Example 2 · lead II · 6 seconds
II25 mm/s · 10 mm/mV
Rate
70/min underlyingThe whole strip averages 70/min · 7 QRS complexes in 6 seconds × 10 = 70/min
Rhythm
Regular underneath, with early beats breaking it
P waves
Upright in II, uniform
P to QRS
1:1 for the sinus beats; the PVCs have no P wave
PR
0.13 s
QRS
0.11 s, narrow
PVCs
2 on this strip
Example 3 · lead II · 6 seconds
II25 mm/s · 10 mm/mV
Rate
76/min underlyingThe whole strip averages 76/min · 8 QRS complexes in 6 seconds × 10 = 80/min
Rhythm
Regular underneath, with early beats breaking it
P waves
Upright in II, uniform
P to QRS
1:1 for the sinus beats; the PVCs have no P wave
PR
0.18 s
QRS
0.08 s, narrow
PVCs
2 on this strip

Don't confuse it with

Want a new strip every time? The ECG Drill in the app draws a fresh, measured example on every try and steers you toward the rhythms you miss. It's part of the Paramedic level, and you can try 5 strips a day free.

Try the ECG Drill

Where the criteria come from

Others in the Ventricular group