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The patient reported no chestpain or shortness of breath. 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. Observations revealed a normal temperature of 36.5°C
She presented to the emergency department after a couple of days of chest discomfort. 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.
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. Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade. Most physicians will automatically be worried about these symptoms.
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Aneurysm 
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