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.

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Rate:

• 132 bpm

Rhythm:

• 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

Axis:

• Normal

Intervals:

• QRS - Normal 

Additional:

• ST Elevation lead aVR
• ST Depression leads II, III, aVF, V4-6
• Likely to reflect rate related demand changes and superimposed atrial activity

Interpretation:

• 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

• SVT 

Textbook

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