tag:blogger.com,1999:blog-1199060416202745408.post7755363403913366784..comments2024-03-19T13:40:12.355+08:00Comments on ECG of the Week: ECG of the Week - 4th February 2013Anonymoushttp://www.blogger.com/profile/09026589956407176781noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-1199060416202745408.post-70538181416973479712013-02-05T00:10:14.482+08:002013-02-05T00:10:14.482+08:00Rate: 150 bpm
Regularity: regular
P-waves: possibl...Rate: 150 bpm<br />Regularity: regular<br />P-waves: possibly present in V1 (long RP, normal PRi), maybe upright in II? As Jason notes with the V-rate we should consider a 2:1 mechanism such as F-waves<br />PRi: normal if present or long RP if VA conduction<br />QRSd: ~140ms<br /><br />Axis: left<br />QTi/QTc: appears normal<br />ST/T-waves: appropriately discordant<br /><br />DDx: VT, AVRT; less likely: AF w/ aberrancy as the morphology is decidedly not a normal RBBB/LBBB.<br /><br />Given the presence of possible P-waves or F-waves in V1 I'd likely give adenosine first line if I treated this in the field. Followed by procainamide if no improvement.Christopherhttps://www.blogger.com/profile/11415988855392944633noreply@blogger.comtag:blogger.com,1999:blog-1199060416202745408.post-66312490546419594932013-02-02T11:33:05.126+08:002013-02-02T11:33:05.126+08:00Wide (broad) complex tachycardia at a rate of abou...Wide (broad) complex tachycardia at a rate of about 150/min. There appears to be positive concordance in the precordial leads. Marked left axis deviation (LAD). Duration of the QRS interval is about 0.15s. <br /><br />My two biggest differentials would be that this is most likely ventricular tachycardia. There appears to be atrial activity at a constant relationship to the QRS complex so there's possibly a 1:1 retrograde conduction to the atria. However, I can't rule out antidromic tachycardia or some preexcited atrial tachyarrhythmia like atrial flutter (rate = 300/min) with 2:1 A-V conduction. I'm sure the ECGs in the following weeks will shed light on the true nature of this WCT. This does not favor SVT with aberrancy. Jason E. Roediger, CCThttps://www.blogger.com/profile/12375233408457825429noreply@blogger.com