ECG Challenge: Abnormal Telemetry Before Cholecystectomy

Philip J. Podrid, MD


June 28, 2021

The correct diagnosis is artifact (Figure 2).

Figure 2. Courtesy of Dr Podrid.


The second part of the telemetry strip shows a regular rhythm at a rate of 60 beats/min. The QRS complex is narrow with a normal axis. There appears to be a P wave before each QRS complex, although an artifact is present that makes the P wave less obvious.

The first part of the ECG tracing shows a rapid rate of 300 beats/min. The waveforms are wide and somewhat irregular in morphology, resembling a ventricular tachycardia. However, during the rapid QRS complexes there are organized and narrow waveforms (↑) unrelated to the wide waveforms. They are occurring at the same rate as the QRS complexes seen during the second part of the tracing. Hence, this is artifact, resulting from brushing her teeth or washing.

Philip Podrid, MD, is an electrophysiologist, a professor of medicine and pharmacology at Boston University School of Medicine, and a lecturer in medicine at Harvard Medical School. Although retired from clinical practice, he continues to teach clinical cardiology and especially ECGs to medical students, house staff, and cardiology fellows at many major teaching hospitals in Massachusetts. In his limited free time he enjoys photography, music, and reading.

You can follow Dr Podrid on Twitter @PPodrid

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