Wednesday, 9 January 2019

ECG of the Week - 7th January 2019 - Interpretation

The following ECG is from a 25 yr old female who presented complaining of palpitations for the last hour.




Click to enlarge
Rate:
  • 205 bpm
Rhythm:
  • Regular
  • Nil P waves visible
Axis:
  • Normal
Intervals:
  • QRS - Normal (80ms)
Additional:
  • Diffuse ST depression leads I, II, III, aVF, V2-6
  • ST Elevation leads aVR, V1 & aVL

Interpretation:

  • Regular narrow complex tachycardia
  • ST segment changes likely secondary to high ventricular rate
  • DDx:
    • AVNRT
    • AVRT (orthodromic)

Management 

Management of SVT is dependent on haemodynamic stability, likely underlying cause, facilities / resources available and patient's wishes.
It usually follows a step-wise approach, assuming no compromise:

  • Vagal maneouvers
  • Adenosine
  • Other drug options
  • DC Cardioversion
  • Simultaneous seek and treat cause - usually absent in most AVNRT
  • Ablation therapy - elective rather than emergent


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.