EKG of the Week 2017 7-2

This EKG comes courtesy of Dr. Dan Peterson.

We thank EP Cardiologist Dr. Seth Keller for his contribution to this edition of EKG of the Week.

 

A 71 year old male presented to the ED complaining of palpitations. His vital signs are: Pulse 150, BP 110/70. His EKG is below.

1.       What is the rhythm?

2.       What are the treatment options?

 

Answer:

The EKG shows a regular narrow complex tachycardia without P waves at a rate of approximately 150. This can be caused by SVT or atrial flutter.

Adenosine can be used initially. This may be therapeutic in the setting of SVT or diagnostic in the setting of atrial flutter. Other options include calcium channel blockers and beta blockers.

 

The EKG shows a regular narrow complex tachycardia without P waves at a rate of approximately 150. This can be caused by SVT or atrial flutter. Remember that whenever you see an SVT at a rate of 150, you should consider atrial flutter in the diagnosis. If you look closely at this EKG in leads III and aVF, you can see flutter waves present (arrows).

This patient was initially treated with diltiazem which resulted in EKG b.

Here you see a heart rate of 75 with flutter waves present (arrows below). This EKG is somewhat interesting in that the atrial rate is relatively slow for atrial flutter (150) and there is 2:1 AV conduction resulting in a ventricular rate of 75.

This patient was already on anticoagulation and had an INR of 2.9. At this point, the patient was cardioverted which resulted in EKG c.

Now the patient is in sinus rhythm at a rate of 50.

The following algorithm is useful in diagnosing tachyarrhythmias: