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- 103 bpm
- Abnormal P wave preceding each QRS
- P wave inversion leads II, III, aVF, V3-6
- Positive P wave in lead aVR and V1
- PR - Short (~100ms)
- QRS - Normal (80ms)
- QT - 330ms (QTc Bazette 430 ms)
- Early R wave transistion
- Very flat T waves through-out
- Ectopic Atrial Tachycardia
The ECG machine failed to recognize the abnormal P wave axis instead reading the ECG as showing delta waves in leads V5-6 and II due to relatively short pr with superimposed p inversion trailing into the QRS.
Remember always look at the ECG yourself, don't trust the machine and take the ECG to the bedside.
What happened ?
The patient was admitted under the cardiology team for further investigation of suspected ACS. Coronary angiogram showed diffuse non-obstructive coronary disease for medical management. Following commencement of beta-blocker therapy the patient's ECG reverted to normal sinus rhythm with unchanged QRS morphology.
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.