{"id":9016,"date":"2025-12-07T00:02:42","date_gmt":"2025-12-07T08:02:42","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=9016"},"modified":"2025-12-04T15:55:56","modified_gmt":"2025-12-04T23:55:56","slug":"guess-the-rhythm-premature-atrial-contractions-pac","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/guess-the-rhythm-premature-atrial-contractions-pac","title":{"rendered":"Guess the Rhythm: Premature atrial contractions (PAC)"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>Answer:<\/strong> Premature atrial contractions (PAC)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The findings of this <strong>ECG<\/strong> indicate <strong>premature atrial contraction (PAC)<\/strong>. <strong>Premature atrial contractions<\/strong> are a type of <strong>arrhythmia<\/strong>, where an extra beat starts in a point in the <strong>atrium<\/strong> other than the <strong>sinoatrial (SA) node<\/strong>, and causes the atria to contract earlier than normal in the <strong>cardiac cycle<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">On the <strong>ECG<\/strong>, the patient\u2019s <strong>heart rate<\/strong> may vary, <strong>rhythm<\/strong> is irregular, and the <strong>P waves<\/strong> are abnormally shaped, because they originate outside the SA node. And because they occur earlier than expected, they might happen at the same time as the <strong>T-wave<\/strong> from the previous, normal contraction. In this case, the two waves will combine, making that T-wave look peaked, or more lumpy than usual, kind of like a camel\u2019s hump. <strong>PR intervals<\/strong> might be shorter than usual when the <strong>ectopic focus<\/strong> is close to the <strong>AV node<\/strong>, or longer than usual if there\u2019s a delay in the AV node. The <strong>QRS complex<\/strong> is typically normal, meaning that the signal passes normally through the AV node and into the ventricles. On the other hand, a QRS complex that&#8217;s wider than normal, meaning longer than 0.12 seconds, means that there\u2019s <strong>abnormal conduction<\/strong> through the <strong>bundle branches<\/strong> and into the walls of the <strong>ventricles<\/strong>. Alternatively, the <strong>P wave<\/strong> might not be followed by a QRS complex at all, in the case of a <strong>non-conducted PAC<\/strong>. Finally, a <strong>compensatory pause<\/strong> might be seen after a normal cycle, if the signal gets to the SA node and causes it to skip a beat.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Learn more about this and other types of cardiac rhythms on Osmosis: <a href=\"https:\/\/www.osmosis.org\/learn\/Arrhythmias_-_Premature_atrial_contractions_(PACs):_Nursing\">Arrhythmias &#8211; Premature atrial contractions (PACs): Nursing<\/a><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Key Takeaways<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>PACs are early atrial beats originating outside the sinoatrial node.<\/strong><\/li>\n\n\n\n<li><strong>ECG shows irregular rhythm and abnormal-shaped P waves.<\/strong><\/li>\n\n\n\n<li><strong>QRS complexes are usually normal unless conduction is abnormal.<\/strong><\/li>\n\n\n\n<li><strong>PACs may cause compensatory pauses after normal beats.<\/strong><\/li>\n\n\n\n<li><strong>Understanding PACs helps in recognizing various arrhythmias on ECG.<\/strong><\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/create\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/01\/Blog_Display_Ads_RN3_2023.png?w=700\" alt=\"\" class=\"wp-image-5064\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/01\/Blog_Display_Ads_RN3_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/01\/Blog_Display_Ads_RN3_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Try Osmosis by Elsevier today! Access your&nbsp;<em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/em>&nbsp;and discover why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Premature atrial contractions (PACs) cause early atrial beats originating outside the sinoatrial node. Recognize PAC features on ECG like irregular rhythm and abnormal P waves.<\/p>\n","protected":false},"author":207,"featured_media":9019,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[10,30,32],"tags":[2442,2445,1849,2373,2446,1853,2443,431,2447,2444,245,2441,2448,2440,1473],"class_list":["post-9016","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clinical-skills","category-np","category-nursing","tag-abnormal-p-waves","tag-arrhythmia-recognition","tag-cardiac-arrhythmia","tag-cardiac-conduction","tag-cardiac-cycle","tag-cardiac-rhythms","tag-compensatory-pause","tag-ecg-interpretation","tag-ectopic-atrial-beats","tag-irregular-rhythm","tag-nursing-education","tag-pac","tag-pac-diagnosis","tag-premature-atrial-contractions","tag-qrs-complex"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Guess the Rhythm: Premature atrial contractions (PAC) - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/guess-the-rhythm-premature-atrial-contractions-pac\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Guess the Rhythm: Premature atrial contractions (PAC) - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Premature atrial contractions (PACs) cause early atrial beats originating outside the sinoatrial node. Recognize PAC features on ECG like irregular rhythm and abnormal P waves.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/guess-the-rhythm-premature-atrial-contractions-pac\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2025-12-07T08:02:42+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-12-04T23:55:56+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/Guess_the_rhythm-Premature-atrial-contractions-PAC.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1080\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"Amber Dortch, FNP\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":[\"Article\",\"BlogPosting\"],\"@id\":\"https:\/\/www.osmosis.org\/blog\/guess-the-rhythm-premature-atrial-contractions-pac#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/guess-the-rhythm-premature-atrial-contractions-pac\"},\"author\":{\"name\":\"Amber Dortch, FNP\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/e734331b70c734d495456c1f43f91a8e\"},\"headline\":\"Guess the Rhythm: Premature atrial contractions (PAC)\",\"datePublished\":\"2025-12-07T08:02:42+00:00\",\"dateModified\":\"2025-12-04T23:55:56+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/guess-the-rhythm-premature-atrial-contractions-pac\"},\"wordCount\":355,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#organization\"},\"image\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/guess-the-rhythm-premature-atrial-contractions-pac#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/Guess_the_rhythm-Premature-atrial-contractions-PAC.png\",\"keywords\":[\"abnormal P waves\",\"arrhythmia recognition\",\"cardiac arrhythmia\",\"cardiac conduction\",\"cardiac cycle\",\"cardiac rhythms\",\"compensatory pause\",\"ECG interpretation\",\"ectopic atrial beats\",\"irregular rhythm\",\"nursing education\",\"PAC\",\"PAC diagnosis\",\"premature atrial contractions\",\"QRS complex\"],\"articleSection\":[\"Clinical Skills\",\"Nurse Practitioner (NP)\",\"Registered Nursing (RN)\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/www.osmosis.org\/blog\/guess-the-rhythm-premature-atrial-contractions-pac#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/guess-the-rhythm-premature-atrial-contractions-pac\",\"url\":\"https:\/\/www.osmosis.org\/blog\/guess-the-rhythm-premature-atrial-contractions-pac\",\"name\":\"Guess the Rhythm: Premature atrial contractions (PAC) - 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Learn to recognize atrial flutter\u2019s unique features and its effects on heart pumping efficiency.","rel":"","context":"In &quot;Clinical Skills&quot;","block_context":{"text":"Clinical Skills","link":"https:\/\/www.osmosis.org\/blog\/category\/clinical-skills"},"img":{"alt_text":"Guess the Rhythm: Atrial flutter","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/Guess-the-rhythm-atrial-flutter.png","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/Guess-the-rhythm-atrial-flutter.png 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/Guess-the-rhythm-atrial-flutter.png 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/Guess-the-rhythm-atrial-flutter.png 2x"},"classes":[]},{"id":9446,"url":"https:\/\/www.osmosis.org\/blog\/guess-the-rhythm-ventricular-fibrillation-vfib","url_meta":{"origin":9016,"position":1},"title":"Guess the Rhythm: Ventricular fibrillation (Vfib)","author":"Amber Dortch, FNP","date":"March 7, 2026","format":false,"excerpt":"A patient presents with an ECG showing a rapid, irregular rhythm with chaotic waveforms. Explore how clinicians recognize a life-threatening arrhythmia on monitor, differentiate it from other rhythms, and determine the immediate management steps used in acute care settings.","rel":"","context":"In &quot;Clinical Skills&quot;","block_context":{"text":"Clinical Skills","link":"https:\/\/www.osmosis.org\/blog\/category\/clinical-skills"},"img":{"alt_text":"Guess the Rhythm: Ventricular Fibrillation (Vfib)","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/03\/Guess-the-Rhythm-Ventricular-fibrillation-Vfib.png","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/03\/Guess-the-Rhythm-Ventricular-fibrillation-Vfib.png 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/03\/Guess-the-Rhythm-Ventricular-fibrillation-Vfib.png 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/03\/Guess-the-Rhythm-Ventricular-fibrillation-Vfib.png 2x"},"classes":[]},{"id":3178,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-shortness-of-breath","url_meta":{"origin":9016,"position":2},"title":"USMLE\u00ae Step 1 Question of the Day: Shortness of Breath","author":"Marina Horiates Kerekes, MD &amp; Team","date":"May 11, 2022","format":false,"excerpt":"This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.\u00a0Today's case focuses on a 73-year-old woman with shortness of breath. Past medical history is notable for hypertension, chronic obstructive pulmonary disease, and type II diabetes mellitus.\u00a0Can you figure it out? A 73-year-old\u2026","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"USMLE\u00ae Step 1 Question of the Day: Shortness of Breath","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T080106.811.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T080106.811.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T080106.811.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T080106.811.webp 2x"},"classes":[]},{"id":4968,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-medication-effects","url_meta":{"origin":9016,"position":3},"title":"USMLE\u00ae Step 2 Question of the Day:\u00a0Medication effects","author":"Marina Horiates Kerekes, MD &amp; Team","date":"January 22, 2025","format":false,"excerpt":"A 67-year-old woman presents with palpitations and fatigue. Dive into her ECG and labs to discover which treatment effectively prevents serious AF complications.","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"USMLE\u00ae Step 2 Question of the Day:\u00a0Medication effects","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Step_2_CK_QOTD_Q4_2024_JTD_6-1.jpg","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Step_2_CK_QOTD_Q4_2024_JTD_6-1.jpg 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Step_2_CK_QOTD_Q4_2024_JTD_6-1.jpg 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Step_2_CK_QOTD_Q4_2024_JTD_6-1.jpg 2x"},"classes":[]},{"id":8117,"url":"https:\/\/www.osmosis.org\/blog\/guess-the-rhythm-asystole","url_meta":{"origin":9016,"position":4},"title":"Guess the Rhythm: Asystole","author":"Amber Dortch, FNP","date":"October 13, 2025","format":false,"excerpt":"Understand the characteristics and clinical significance of asystole, an emergency cardiac rhythm requiring immediate intervention by healthcare teams.","rel":"","context":"In &quot;Clinical Skills&quot;","block_context":{"text":"Clinical Skills","link":"https:\/\/www.osmosis.org\/blog\/category\/clinical-skills"},"img":{"alt_text":"Guess the rhythm: Asystole","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Guess-the-rhythm-Asystole.png","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Guess-the-rhythm-Asystole.png 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Guess-the-rhythm-Asystole.png 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Guess-the-rhythm-Asystole.png 2x"},"classes":[]},{"id":669,"url":"https:\/\/www.osmosis.org\/blog\/nclex-qotd-normal-pqrst-wave","url_meta":{"origin":9016,"position":5},"title":"NCLEX-RN\u00ae Question of the Day: Normal PQRST wave","author":"Paige Randall, PhD, MS, RN, CNE &amp; Elizabeth Lucas, EdD, RN, CNE","date":"July 12, 2023","format":false,"excerpt":"Get ready for the NCLEX-RN\u00ae exam by honing your skills in ECG interpretation. Today\u2019s question focuses on recognizing a normal PQRST wave. 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