- The first beat has a normal P wave and is normal (i.e. a sinus beat)
- The next four beats, at about 100/min, have abnormal (inverted) P waves, and this is an atrial tachycardia
- After a pause the next two beats have normal P waves and are in sinus rhythm at about 43/min
- After two sinus beats there is an extrasystole with an inverted P wave; this is an atrial extrasystole (PAC)
- Normal axis
- The QRS complexes, ST segments and T waves are normal
Since the patient had her symptoms at the time of the recording, we can be confident that the ECG findings explain them. Atrial extrasystoles are not a manifestation of cardiac disease, but the atrial tachycardia may be and will need treating on symptomatic grounds.
What to do ?
Ensure that there is no other evidence of heart disease. She should stop smoking and avoid alcohol, coffee and tea. A beta-blocker will probably prevent the tachycardia.