Whilst clinical correlation with any investigation is necessary we often get ask to review ECG's 'hot of the press' for patients that haven't been assessed yet and a structured approach in these scenarios is even more important.
On to this weeks ECG.
 |
| Click to enlarge |
Rate:
- 150
- Regular without p waves
- LAD (-39 deg)
- PR - No visible p waves
- QRS - Normal (100-120ms)
- QT - 280ms (QTc Bazette 440ms)
- Possible ST depression V3-6
- Flutter waves visible in V1
- T Wave Inversion V1-2, aVL
- LVH (aVL>11mm)
Interpetation:
- Narrow Complex Tachycardia
- Ventricular rate 150bpm
- Atrial Flutter 2:1 Block
- Other differentials include AVNRT / AVRT however the rate is usually higher in these
- 'Mapping' of flutter waves may be helpful, this may be easier if paper speed is altered e.g. 50mm/sec
- Trial of vagal manoeuvers of adenosine may help differentiate Atrial Flutter
- This patient recieved adenosine, rhythm strip below, revealing obvious flutter waves.
 |
| Click to enlarge |
- Described by Sir Thomas Lewis in 1931
- Place RA electrode on right sternal edge 2nd intercostal space
- Place LA electrode on right sternal edge 4th intercostal space
- Lead I then principally reads atrial electrical activity
- May help magnify flutter or fibrillatory waves
- May benefit from increasing gain and adjusting paper speed to 50mm/sec
- Listen to the excellent EMCrit podcast on the Lewis Lead here
- Or read more about it here
References / Further Reading
Dr Smith's ECG Bog
- What's the rhythm ? Here
- ECG Quiz - Unusual Flutter Here
- Bakker AL, Nijkerk G, Groenemeijer BE, Waalewijn RA, Koomen EM, Braam RL, Wellens HJ. The Lewis lead. Circulation. 2009 Jun 23;119(24):e592-3. Full Text
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.
No comments:
Post a Comment