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male with pertinent past medical history including Atrial fibrillation, atrial flutter, cardiomyopathy, Pulmonary Embolism, and hypertension presented to the Emergency Department via ambulance for respiratory distress and tachycardia. Bedside ultrasound showed volume depletion and no pulmonary edema. SVT with aberrancy?
The ECG and long lead II rhythm strip in Figure-1 — was obtained from a COVID positive patient with persistent tachycardia not responding to Diltiazem. Figure-1: The initial ECG — obtained from a patient with persistent tachycardia. ( How would YOU interpret this tracing? How to manage the patient?
Multifocal Atrial Tachycardia 2. AFib is the irregularly irregular rhythm that is most commonly confused with MAT — and , AFib is much, much, much more common than true MAT. The rhythm is indeed irregularly irregular, so atrial fibrillation must be considered. Sinus with multifocal PACs 3. Sinus with multifocal PVCs 4.
NOTE: For more on ECG recognition of RVH and/or pulmonary hypertension ( re the qR pattern in lead V1 ) — See ECG Blog #234 and Blog #248. Because of this, it is uncommon to see sinus tachycardia with a prolonged PR interval. This is precisely what we see in Figure-6. Unfortunately — I lack this information.
The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. The Initial ECG in Today's Case: As per Dr. Meyers — the initial ECG in today's case shows sinus tachycardia with bifascicular block ( = RBBB/LAHB ). Sinus Tachycardia ( common in any trauma patient. ).
ECG Blog #65 — for an example of MAT in a patient with chronic pulmonary disease ( plus more on the differential diagnosis of MAT ). ECG Blog #71 — Regarding the Ashman Phenomenon with AFib. The September 30, 2019 post in Dr. Smith’s ECG Blog — for an example of “MAT”, but without the tachycardia.
The combined solutions are expected to enhance performance and streamline workflows for electrophysiologists during catheter ablation procedures to treat atrial fibrillation , AFib. 1 Approximately 33 million patients worldwide are living with AFib. 1 Approximately 33 million patients worldwide are living with AFib.
The morphology of V2-V4 is very specific in my experience for acute right heart strain (which has many potential etiologies, but none more common and important in EM than acute pulmonary embolism). CT angiogram showed extensive saddle pulmonary embolism. He had multiple cardiac arrests with ROSC regained each time.
Further ultrasound showed no B-lines (no pulmonary edema). WPW Cardiac arrhythmias ( especially AFib ). The heart rate is too fast for this poor filling. Preload must be increased and the heart rate slowed in order to allow more LV filling. These patients are often on beta blockers to prevent such a scenario.
Smith : This is classic for pulmonary embolism (PE). Acute pulmonary embolism was confirmed on CT angiogram: The patient did well. See our other acute right heart strain / pulmonary embolism cases: A man in his 50s with shortness of breath Another deadly triage ECG missed, and the waiting patient leaves before being seen.
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