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- Mean ventricular rate 60 bpm
- Irregular ventricular complexes
- Flutter / fib waves best seen in leads aVF & V1
- LAD
- QRS - Normal (80ms)
- Early R wave transition between V1 & V2
- Subtle ST depression leads V4-6
- Flat T wave lead aVL
Interpretation:
- Atrial fibrillation
- Rate controlled
- Onset
- Acute vs chronic
- Duration
- Rate disturbance
- Rapid ventricular response
- Normal rate
- Bradycardia - may be secondary to therapy or tachy/brady syndrome
- Complication of AF
- Cardiac failure
- Hypotension
- Ischaemia
- Thromboembolic / CVA
- Current therapy
- Anti-coagulation
- Anti-arrhythmics
- Complications of therapy
- Drug toxicity
- Bleeding
- Precipitant / Causative factors
- Infection / Ischaemia / Structural / Endocrine / Metabolic
- European Society of Cardiology Guidelines 2010
- American College of Cardiology Foundation / American Heart Association / Heart Rhythm Society Guidelines 2011 Update
- American College of Cardiology Foundation / American Heart Association / Heart Rhythm Society 2006 Guideline
- Canadian Cardiovascular Society Guidelines 2010
- NICE Guideline 2006
- Ottawa Aggressive Protocol for Recent Onset Atrial Fibrillation/Flutter
- Western Australia Cardiovascular Health Network Guidelines 2011
What happened ? This patient had known chronic atrial fibrillation and acute presentation was secondary to an acute embolic CVA.
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.
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