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.

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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:

• http://www.rch.org.au/clinicalguide/guideline_index/Supraventricular_Tachycardia_SVT/

References / Further Reading

Life in the Fast Lane

• Paediatric ECGs
• SVTs
• Accelerated Junctional Rhythm

Textbook

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