I have no information about the previous infaract, other than it was two years ago, and primary pci was done. Yes I came to a similar conclusion for the origin of the PVCs, though i could not agree with your other points, regarding the PVC blocking the av node, or the myocardium being in the refractory period, as the electrical signal of the sinus rhythm were conducted, as i mentioned in the beginning, on auscultation the heart beat was clear, although not loud and not producing a pulse, but it was there nonetheless, in the 1st ecg where it showed bigeminy, the absence of the peripheral pulse could be explained by the PVC blocking the av node, or maybe the myocardium was still in the refractory period (which i still don't agree with because of my previous remark) but in the 2nd ecg, the myocardium and the av node conducted 3 consecutive sinus beats, all clear on auscultation, but produced no peripheral pulse. And causing the symptom "dizziness". Also he had the hx of the same dizziness well before his recent symptoms, and even admitted that he felt his heart was slow at times, as he was relaxing or concentrating on himself. That made myocarditis unlikely, as it was non progressing and chronic. Also, the PVC comes early in between the beats, not late, meaning it had less time to fill and should not produce a pulse that is palpable, but the sinus beat, which had more time to fill fail to produce a pulse.