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°C and a normal bloodpressure of 123/83 mm Hg. A 24-hour 12-lead ECG revealed sinus rhythm, frequent atrial premature beats, paroxysmal atrialflutter with an atrialflutter burden of 9.37% and no paroxysmal ST-T abnormalities. Cystic formation of the foramen ovale Aortic sinus aneurysm Left.
The ECG was interpreted as showing atrialflutter with 2:1 conduction. The heart rate could be compatible with that of a 2:1 conducted atrialflutter. Also, lead I could give the initial impression of showing flutter waves. The ECG shows what is likely an atrial ectopic rhythm with a left anterior hemiblock.
Look for Vascular Etiology -- think of these while doing H and P: --Bleeding: ruptured AAA, GI bleed, ruptured ectopic pregnancy, other spontaneous bleed such as mesenteric aneurysms. Any ED systolic bloodpressure less than 90 or greater than 180 mm Hg (+1) 4. h/o heart disease (+1) 3. QRS duration greater than 130 msec (+2) 6.
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