Premature ventricular beats
An Unexpected Finding on a Routine ECG
A 68-year-old man is referred after an abnormal routine ECG. He reports no chest pain, breathlessness, or syncope.
Look for
- Beats occurring earlier than expected.
- Premature QRS complexes with a different, broad morphology.
Where to look. On the rhythm strip, compare timing, QRS shape, and P waves of early beats with the underlying rhythm.
An early ventricular impulse activates the ventricles by a different route. Describe the premature beats without inferring their daily burden or cardiomyopathy from this ECG alone.
The underlying rhythm is slow. The question targets premature beats without inferring their 24-hour burden.
References & provenance
The ECG Made Easy, 9e, ch. 4, PDF 100–102.
A Case of Premature Ventricular Contraction-Induced Cardiomyopathy
Michael Mazar; Shipra Hingorany. A Case of Premature Ventricular Contraction-Induced Cardiomyopathy. 2025. doi:10.7759/cureus.91034. Figure 1. CC BY 4.0. CC BY 4.0
Adaptation: cropping and removal of headers/annotations outside the tracing where applicable; metadata removed. Waveforms have not been redrawn.
Compared with the published source; no independent clinical validation is claimed.
Original annotations & limitations
Extrasystoles ventriculaires
Homme de 68 ans adressé après ECG de routine; bradycardie sinusale avec ESV; il ne rapporte ni douleur thoracique, ni dyspnée, ni syncope.
Question sur la prématurité et la morphologie; ne pas exiger le diagnostic de cardiomyopathie induite par ESV sur ce seul tracé.