Aidey
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Guess the EKG
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VFlutter
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I am leaning towards Aberrant Atrial Flutter or an Antidromic AV Reentrant Tach instead of V tach
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Brandon O
Puzzled by facies
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1:1 flutter.
Saw a good case report about one of these in an infant a while back. Gnarly stuff.
Saw a good case report about one of these in an infant a while back. Gnarly stuff.
OP
OP
Aidey
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Spoil sport
I'll still post the 12 lead. The pt was quite stable considering. Conscious, able to answer questions, radial pulse, EtCO2 of 25 mm/hg.
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Aidey
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Why abberant?
Brandon O
Puzzled by facies
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I presume he means aberrant conduction. 1:1 AV conduction, at this rate, is by definition inappropriate, and usually implies an accessory pathway.
I think this is the first elderly patient I've seen with this rhythm; nice strip. Would love more info on the case if you can.
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Aidey
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I assumed that was what he meant, I'm curious why. Abberant conditions are typified by wide complex QRSs and this one is narrow.
Brandon O
Puzzled by facies
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Looks borderline to me, right around 120.
Brandon O
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I would... but it seems to have disappeared. It was at ERStories.com, this url: http://erstories.net/archives/3700
Fortunately the Wayback seems to have it: http://web.archive.org/web/20110620144717/http://erstories.net/archives/3700
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Aidey
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Counting the flutter wave sure. If someone wants to bust out a geometry book I bet we can figure out the actual width of the QRS and I'm guessing it is around .06.
I've attached the 12 lead.
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VFlutter
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I was looking at this on my phone and it looked a little wide to me, but you are right it usually implies a wide complex QRS but as I understand it can also mean abnormal conduction such as the 1:1.
Also here is a good picture I found on Google
VFlutter
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Just some random guesses (Not too much experience with EKGs )
-Possible history of COPD/Pulmonary hypertension. Seems to go along with that whole chain of events with cor pulmonale. Chronic Pulmonary hypertension leads to the RAE/LVH which usually leads to atrial arrhythmia (A fib/ Flutter) And the Right Axis.
- Or I think WPW can create Right axis deviation which may tie into that 1:1 conduction or preexcitation going on.
I don't get how this is guessing - I hope you don't tell your patients "I think you'll be OK, but really I'm just making a guess"...
Wide complex regular tachycardia at a rate of just under 300. That's VT until proven otherwise, but given the P waves I would guess atrial flutter with a bundle branch block.
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Aidey
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Well, considering I already know what it is, I wasn't the one guessing, you guys were. However, someone got it in the second post, so not much guessing going on.
It is not wide. It is 1:1 flutter with the flutter wave buried in the beginning of the QRS.
It is not wide. It is 1:1 flutter with the flutter wave buried in the beginning of the QRS.
MSDeltaFlt
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All the articles you've posted refer to pediatrics. This pt is late middle aged. In all three leads there appears to be a near verticle wave form indicating the QRS which is why, without a 12 lead, I'm going with SVT.
mycrofft
Still crazy but elsewhere
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What were the clinical presentation, primary complaint, and the outcome?
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Aidey
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The 12 lead is a few posts up. The pt self converted to 2:1 flutter before we had a chance to do anything. The rate went from 280 to 140.