Wednesday, 17 May 2017

ECG of the Week - 15th May 2017 - Interpretation

The following ECG is from an 81yr old female who presented with a 48hr history of palpitations. She underwent a cardioversion for an atrial arrhythmia 1 year ago. Her medications include metoprolol, digoxin and eliquis.

Click to enlarge

  • 132 bpm
  • Regular
  • Possible atrial activity seen in leads I, II, III and aVF
  • Lead II suggests inverted small atrial waves seen with ST segment and T-QRS interval
  • Normal
  • QRS - Normal 
  • ST Elevation lead aVR
  • ST Depression leads II, III, aVF, V4-6
    • Likely to reflect rate related demand changes and superimposed atrial activity


  • Regular narrow complex tachycardia
  • Differentials:
    • Atrial flutter with 2:1 block - favoured due to the patient's history of AF
    • Atrial tachycardia with 2:1 block

What happened ?

Following screening for acute electrolyte disturbance, non-cardiac precipitant, drug toxicity and ensuring compliance with coagulation regime the patient underwent an uneventful DC cardioversion under procedural sedation.

References / Further Reading

Life in the Fast Lane

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

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