[Solved]: A 20 year old college student presents to the ER…

A 20 year old college student presents to the ER complaining of a racing heart and palpitations. An ECG is ordered and the following (next page) strip is obtained. While the patient is being prepped, the PA asks the patient some questions. The patient reveals that he is under a great deal of stress due to an exam in his physiology course. He has pulled 2 all nighters in a row trying to get ready for an exam. Right before the exam he was feeling really drowsy and sluggish so he has consumed 2 Red Bulls and ordered an extra-large coffee with 3 shots of espresso before heading in to take the exam. While taking the exam, he began to feel nauseous and felt his heart racing. He came to the ER worried he could be having a heart attack. After examining the ECG tracing, the physician assistant reassured the patient that everything is fine with his heart. She then begins to counsel him on healthy study habits and the potential detrimental effects of no sleep and too much caffeine. The patient is discharged home to take a lengthy nap. What is your interpretation of the tracing below? Why is the p wave absent in the abnormal beat?