Friday, 25 September 2015

ECG of the Week - 21st September 2015 - Interpretation

The following ECG is from a 70yr old who presented with lethargy. Past medical history of Aortic Valve Replacement with post operative AF. Vital signs: BP 85/60 RR 18 Sats 94% (Room Air). Check out the comments from our original post here.




Click to enlarge

Rate:
  • Mean ventricular rate bpm
  • Atrial rate ~300 bpm
Rhythm:
  • Atrial flutter with variable high grade block (4:1 --> 10:1)
Axis:
  • Normal
Intervals:
  • QRS - Normal (80ms)
Segments:

  • ST Depression leads V3-4 likely secondary to superimposed flutter waves

Additional:

  • 'Saw tooth' baseline appearance
  • Flutter waves - negative in inferior leads and positive in V1

Interpretation:

  • Atrial flutter
    • Typical counter-clockwise
    • High grade variable block

What happened ?

Following discussion with the patient's cardiologist they were DC cardioverted with reversion to sinus rhythm and improvement in heart rate to 60-70 bpm.

More information on flutter classification / types:


Both papers provide in-depth reviews of atrial flutter classifications, both new & old, and how the ECG and advanced EP techniques can help differentiate them

References / Further Reading

Life in the Fast Lane

Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.