what are the features that make this an irregularly irregular rhythm?

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It is irregularly irregular rhythm QRS complexes are preceded by P wave PR interval is constant with normal P wave Ectopic p wave with different morphology is visible Ectopic p wave has different PR interval Therefore it is Multiple premature atrial complexes

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Agree with all It is atrial activity which is causing irregular rhythm Therefore it is INCESSANT ATRIAL TACHYCARDIA

What is incessant?
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D/D of irregularly irregular rhythm.... 1. AF. 2. A flutter 3. Multifocal atrial tachycardia....it requires at least 3 distinct P wave morphologies. Here it seems to be multiple premature atrial contractions.

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It's a case of irregularly irregular rhythm.it might be a case of premature atrial complexes.

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Multifocal ATRIAL TACHYCARDIA. IS ONE OF THE COMMON CAUSE OF IRREGULARLY IRREGULAR HR.

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Absence of P wave Biphasic in v2 SVD

Irregular rythm,frequent PAC

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Atrial fibrillation.

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Inferolateral Ischeamia with Atrial fibrillation

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There are premature beats everywhere with qrs complexes.

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