Which rhythm is typically characterized by a heart rate of 40-60 bpm with P waves inverted or buried in the QRS?

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Multiple Choice

Which rhythm is typically characterized by a heart rate of 40-60 bpm with P waves inverted or buried in the QRS?

Junctional rhythm. When the impulse comes from the AV junction, the atria are activated retrogradely, so the P waves are often inverted in the inferior leads and may appear after the QRS or be hidden within it. The ventricles still depolarize through the normal His-Purkinje system, so the QRS is typically narrow, and the rate sits in the 40–60 bpm range—the classic escape rhythm from the AV junction. This pattern distinguishes it from sinus tachycardia (upright P waves before each QRS with a faster rate), ventricular tachycardia (usually wide QRS, no clear P waves, rapid rate), and atrial fibrillation (no discrete P waves and an irregular rhythm).

Junctional rhythm. When the impulse comes from the AV junction, the atria are activated retrogradely, so the P waves are often inverted in the inferior leads and may appear after the QRS or be hidden within it. The ventricles still depolarize through the normal His-Purkinje system, so the QRS is typically narrow, and the rate sits in the 40–60 bpm range—the classic escape rhythm from the AV junction.

This pattern distinguishes it from sinus tachycardia (upright P waves before each QRS with a faster rate), ventricular tachycardia (usually wide QRS, no clear P waves, rapid rate), and atrial fibrillation (no discrete P waves and an irregular rhythm).

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