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We are throwing a bit of a curve ball with this rhythm strip. There are a couple of reasons for this: (1) The small amplitude and the morphology of the QRS complexes can cause some confusion when examining this rhythm strip; (2) The PR interval is prolonged at 0.24 seconds; (3) The QRS complexes are wider than 0.12 seconds. Recall that part of the criteria for normal sinus rhythm is to have intervals within the normal range. This patient has a prolonged PR interval—which makes this a first-degree heart block—and a wide QRS complex. Note that this is still a sinus rhythm, but not normal sinus rhythm. This slight difference in nomenclature is usually overlooked by many clinicians and authors, but is the correct terminology.
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