Wednesday, 6 March 2013

ECG of the Week - 4th March 2013 - Interpretation

Again no clinical information on this case.
 
 
 
 
 
Click to enlarge
Rate:
  • Ventricular ~ 85 bpm
  • Atrial ~ 250-300 bpm
Rhythm:
  • Regularly irregular
    • R-R Interval cycles from 520 ms and 960 ms
Axis:
  • Normal (60 deg)
Intervals:
  • PR - No p waves visible
  • QRS - Normal (80-100ms)
  • QT - 380ms (QTc Bazette variable due to RR irregularity)
Segments:
  • ST Elevation V3 1mm
    • Coincides with flutter wave superimposition
Additional:
  • Flutter waves best visualised in II, III, aVF, aVL
    • Positive V1
    • Typical anticlockwise
  • QRS alternans
    • Second complex in pair slight differing voltage
Interpretation:
  • Atrial flutter with variable block

References / Further Reading
 
Life in the Fast Lane
 
  • Atrial flutter here
Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.