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

• SVT

Textbook

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