Image 1 : The ECG of
the middle-age man who was diagnosed as myocarditis.
Image 2 - ladder
diagram
As we can see, beats
# 1, 2 are normally conducted complexes. Beat #3 is an interpolated PVC. Beat # 4 is sinus rhythm but
with the prolonged PRI and beat 5 is also a PVC with retrograde
atrial capture and then
the cycle repeats. Notice that beats # 3,8,13 are interpolated PVCs and beats # 4,9,14 have the prolonged PRI. The
possible interpretation for the prolonged PRI of beat 4,9,14 is the concealed retrograde conduction of the
premature ventricular complex. The
sinus P waves after the interpolated PVCs reach the AV node during its relative
refractory period ( caused by the concealed retrograde conduction of the
interpolated PVCs), so they take much more time to penetrate the AV node. That
phenomenon created the long PRI (beats #4, 9 and 14).
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