A 64-year-old man is presenting to the Emergency department complaining of palpitation, that he describes as the sensation of forceful thumps in his chest. He suffered from a myocardial infarction 2 years ago, and has been stable with infrequent mild angina on effort.

• Sinus bradycardia
• Premature ventricular complexes in a pattern of bigeminy, with retrograde ventricular-atrial conduction
• Ventricular rate 68/min
• Inferior myocardial infarction, age undetermined

FAQ: Could the premature complexes be junctional with aberrant conduction (which would explain the retrograde P waves)?

Answer: The right-superior axis deviation, RBBB with monophasic pattern in the right precordial leads (instead of rSR’ pattern), and rS in V5 and V6 (instead of qRS pattern) suggest PVCs rather than PJCs with aberrant conduction.