1. Stepwise interpretation of ECG ID 352 –Sinus rhythm With premature atrial complexes

2. ID 352 – 62 year old man with palpitation

3. Can you see P waves? ID 352 – 62 year old man with palpitation

4. Yes – There is sinus rhythm with premature atrial complexes ( the P waves marked by an arrow ) Every 3 rd P is premature ( trigeminy ) - The sinus P waves show no evidence of right or left atrial enlargement ID 352 – 62 year old man with palpitation

5. Let’s now look at the QRS complexes: There is normal QRS axis (between 0 and 90 degrees) ID 352 – 62 year old man with palpitation

6. The QRS duration is normal : There is no right bundle branch block, left bundle branch block or non‐specific block ID 352 – 62 year old man with palpitation

7. There is no right ventricular hypertrophy or left ventricular hypertrophy ID 352 – 62 year old man with palpitation

8. There are no QRS signs of myocardial infarction –There are normal ST segment and normal T waves ID 352 – 62 year old man with palpitation

9. ID ID 352 – Final diagnosis: Sinus rhythm, 83 bpm, with atrial premature complexes in a pattern of trigeminy. Otherwise, a normal ECG.