Rhythm Interpretation: electrocardiographic polyuria (too much P…waves) and how to successfully break down complicated rhythms

ECG Weekly Workout with Dr. Amal Mattu


A 54-year-old man presents to the emergency department reporting that his heart feels like it is skipping beats. He is noted to be bradycardic on arrival. The following ECG is obtained:

Before watching the video, look closely at this ECG and ask yourself:

  1. What is the heart rate and rhythm?
  2. What is the most likely cause of the changing morphology of QRS complexes?
  3. What is the most likely diagnosis?