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Atrial dilatation in Atrial fibrillation : A query with multiple twists!

Dr. S. Venkatesan MD

When atrial fibrillation (AF) begins, it can start with a single focus, degenerating to multiple wavelets, and it spreads throughout the entire surface area of both atria. A fibrillatory wave that occurs at a rate of more than 600 beats per minute can cause fatigue in the long run, leading to atrial dilation.

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Atrial fibrillation? Multifocal Atrial Tachycardia? Don't look at computer read until AFTER you interpret!

Dr. Smith's ECG Blog

Here is the computer interpretation: ATRIAL FIBRILLATION WITH RAPID VENTRICULAR RESPONSE WITH ABERRANT CONDUCTION OR VENTRICULAR PREMATURE COMPLEXES LEFT AXIS DEVIATION [QRS AXIS beyone -30] NONSPECIFIC ST and T-WAVE ABNORMALITY The over-reading physician confirmed this diagnosis, which is incorrect. It is not atrial fibrillation.

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Wide-complex tachycardia: VT, aberrant, or "other?"

Dr. Smith's ECG Blog

The patient had a history of paroxysmal atrial fibrillation and several cardioversions. Instead, the rate of 150, plus the history of AF, suggested atrial flutter. A close inspection of lead II showed P or flutter waves at a rate of about 300 bpm, also supporting atrial flutter. Note of Caution!

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Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

Dr. Smith's ECG Blog

The rhythm differential for narrow, regular, and tachycardic is sinus rhythm, SVT (encompassing AVNRT, AVRT, atrial tach, etc), and atrial flutter (another supraventricular rhythm which is usually considered separately from SVTs). Therefore this patient is either in some form of SVT or atrial flutter. If so, why?

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Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Dr. Smith's ECG Blog

Academic Emergency Medicine., Academic Emergency Medicine, 2003 Volume 10, Number 5 539-540. Methods : Our prospective study at 2 academic EDs included adults with presyncope and excluded patients with syncope, mental status changes, seizure, and significant trauma. Thiruganasambandamoorthy, V., Sivilotti, M., Mukarram, M.,