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This encounter shows a fast rate over 100 bpm, with a regular rhythm and P waves, indicating sinus tachycardia The extremely long delay between the P wave and QRS indicates first degree heart block Additionally, ectopy is seen in this encounter, in the form of premature ventricularA premature ventricular contraction (PVC) is a relatively common event where the heartbeat is initiated by Purkinje fibers in the ventricles rather than by the sinoatrial nodePVCs may cause no symptoms or may be perceived as a "skipped beat" or felt as palpitations in the chest Single beat PVCs do not usually pose a danger The electrical events of the heart detected by theThe vagus nerve is an efferent tract from the medulla to the heart, causing sinus bradycardia, junctional rhythm, AV block, bigeminy, and nodal beats Bradycardia can also progress to sinus arrest, asystole, or ventricular fibrillation 3–7,10 An episode of the OCR may lead to bradycardia terminating in asystole or to asystole with n