Wednesday, 31 May 2017

ECG of the Week - 29th May 2017 - Interpretation

The following ECG is from an 6 yr old male who presented to a rural hospital complaining of palpitations and dysponea. The nearest large / tertiary hospital is1500km (930 miles) aways.


Click to enlarge

Rate:
  • 150 bpm
Rhythm:
  • Regular narrow complex
  • SVT with retrograde atrial activity within QRS-T segment
Axis:
  • Normal (-33 deg)
Intervals:
  • QRS - Normal
Additional:

  • Retrograde P waves visible all leads with QRS-T
    • Inverted leads II, III, aVF
  • High voltages in all leads
    • At upper limit of normal for age

Interpretation:

  • Regular narrow complex tachycardia
  • Retrograde P waves

Differential diagnosis include:

  • AVNRT (Fast-Slow)
  • Accelerated junctional tachycardia
  • AVRT

What happened ?

The patient thankfully reverted following vagal maneouvers and paediatric cardiology follow-up was arranged in addition to echo. The management of SVT in children and adults should follow as stepwise process whilst simultaneously assessing and treating potential causative factors. The following is a sample treatment algorithm from the Royal Children's Hospital Melbourne:


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.