& x20;The following ECG Represrepresent? - AIIMS M.Sc. Nsg Entrance exam-2026

AIIMS M.Sc. Nsg Entrance exam-2026

Medical & Surgical Nursing

Hard

Appeared in: AIIMS M.Sc. Nsg Entrance exam-2026

Explanation

The ECG displays a rhythm where every normal sinus beat is followed by a premature ventricular contraction (PVC).
This consistent 1:1 pattern of a normal beat to a PVC is the definition of ventricular bigeminy.
The PVCs are identified by their characteristic wide (greater than 0.12 seconds) and bizarre QRS morphology, which is not preceded by a P wave.
The regularity of this abnormal pattern distinguishes it from other arrhythmias like atrial fibrillation.

Option A: Supraventricular tachycardia (SVT) is a rapid, regular rhythm with narrow QRS complexes. The provided ECG has wide QRS complexes and is not necessarily tachycardic.
Option C: Second-degree heart block involves a failure of conduction from the atria to the ventricles, resulting in P waves that are not followed by a QRS complex (dropped beats). This ECG shows extra beats (PVCs), not dropped beats.
Option D: Atrial fibrillation is a chaotic, irregularly irregular rhythm with no identifiable P waves. The ECG in the image shows a distinct and regular repeating pattern.

Visual 1: Infographic - A comparative chart showing the ECG patterns of ventricular bigeminy (1 normal:1 PVC), trigeminy (2 normal:1 PVC), and quadrigeminy (3 normal:1 PVC). This helps differentiate between common PVC patterns.
Visual 2: Diagram - An illustration of the heart's electrical conduction system, highlighting the origin of a normal sinus beat in the SA node versus the origin of a PVC in an ectopic focus within the ventricular muscle. This clarifies why the QRS is wide.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain ECG interpretation of ventricular arrhythmias as background academic context rather than a clinical decision trigger.
Ventricular bigeminy can be benign or indicate underlying issues like electrolyte imbalances (hypokalemia, hypomagnesemia), myocardial ischemia, or cardiomyopathy. Patients may report palpitations or feeling 'skipped beats'.
Nursing assessment should include checking vital signs, assessing for symptoms like dizziness or chest pain, and reviewing the patient's medications and recent electrolyte lab values.
What if the pattern was two normal beats followed by one PVC? This would be classified as ventricular trigeminy, which is generally considered less urgent than bigeminy but still warrants investigation into the underlying cause.

How to Approach the Question

This is an image-based ECG interpretation question. Start with a systematic approach.
Step 1: Analyze the rhythm. Is it regular, regularly irregular, or irregularly irregular? In this case, there's a repeating, regular pattern of abnormality.
Step 2: Examine the QRS complexes. Are they narrow (less than 0.12s) or wide (greater than 0.12s)? Notice the presence of both narrow and wide complexes.
Step 3: Identify the pattern. Observe that each narrow (normal) beat is followed by a wide (abnormal) beat.
Step 4: Define the abnormal beat. The wide QRS with no preceding P-wave is a Premature Ventricular Contraction (PVC).
Step 5: Name the pattern. A 1:1 ratio of normal beats to PVCs is called ventricular bigeminy. Match this finding to the correct option.

Concept Tested & Keywords

Concept Tested: ECG interpretation of ventricular arrhythmias.
Stem keywords: ECG, Represents
Lead-in keywords: BEST, MOST RELEVANT CLUE
Clinical cues: The repeating pattern of a normal beat followed by an abnormal beat is the key visual cue.

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