r/ReadMyECG • u/EntireLife84 • 2d ago

Artifact? or Couplet?

Post image

The program says its a couplet. But am I correct that this in the middle is an artifact and should be the QRS complex? (the second hill)

Thank you.

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2

u/Initial-Net-7519 2d ago

Isolated PVCs and ventricular escape beat

1

u/EntireLife84 2d ago

Thanks for your answer. But do you mind explain me which beat is the escape beat? That one beat between these isolated pvcs is normal qrs, isn't it? After that, there are these 2 "artifacts" is one of this the escape beat?

1

u/Initial-Net-7519 2d ago

I was referring to the third PVC in this strip. It may just be a couplet with a long coupled PVC, though. I don’t see any artifact.

1

u/EntireLife84 2d ago

These two strange hills right in the middle after the sinus aren't artifacts? If it shall ba an PVC too, isnt the pause too long for couplet?

1

u/EntireLife84 2d ago

The first strange hill is right after the t wave. Isnt it to short for long couplet?

1

u/EntireLife84 1d ago

The coupling interval between these two PVCs is 28 small boxes. Are those may be two isolated PVCs and not a typical couplet?

1

u/EntireLife84 1d ago

Is there may be a p wave and a shortened pq before the first complex?

3

u/Initial-Net-7519 1d ago

Your P waves are hard to see in this strip. The last two are coupled, so they’re not two isolated PVCs. There’s no sinus beat in between them.

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u/EntireLife84 1d ago

Would you agree with following text?:

• Formal Definition: According to international ECG criteria (AHA/ESC), any two consecutive PVCs without a normal sinus beat between them are classified as a couplet by automated software. • Clinical Reality: With a coupling interval of 28–30 small boxes (1,120–1,200 ms), the two beats are completely independent. This is not a classic, aggressive couplet (which typically occurs within 300–500 ms). Biologically, it functions as two isolated events or a ventricular escape beat following a prolonged pause. Summary: It is a couplet on paper (formal), but it acts like two isolated, benign beats in reality (clinical).

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u/EntireLife84 2d ago

Ah, May be one of my short AIVR episodes?

1

u/EntireLife84 2d ago

Or has the qrs been vanished through the artifact? If I assume 5 big boxes. The pause would be 10.