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In healthy individuals occurs during exercising or strong emotions. AFIB/AFL – atrial fibrillation or atrialflutter episodes. Other times, an irregular recording can signal a medical emergency, such as a myocardial infarction or a dangerous arrhythmia. Usually does not exceed 160 bpm.
To me, it was clearly atrialflutter with 1:1 conduction. The rate of 280 is just right for atrialflutter. The waves look like atrialflutter waves, NOT like a wide ventricular complex. Because the patient was exercising, which increases sympathetic tone, facilitating AV conduction.
The WCT is interrupted by a series of variable-morphology QRS complexes, with atrialflutter waves note in II, III, and aVF. Detail of Flutter waves The rate of the flutter waves matches the rate of the WCT (about 200/m), proving that the presenting WCT had been 1:1 atrialflutter.
The Differential Diagnosis is: SVT with aberrancy(#) [AVNRT vs. WPW (also called AVRT*)] Atrialflutter with 1:1 conduction, with aberrancy VT coming from the anterior fascicle ( fascicular VT )@ *AVRT = AV Reciprocating Tachycardia (Tachycardic loop that uses both the AV node and an accessory pathway.
Atrialflutter with 2:1 conduction. The atrialflutter rate is approximately 200 bpm, with 2:1 AV conduction resulting in ventricular rate almost exactly 100 bpm. Further history revealed she had new onset atrialflutter soon after her aortic surgery, and was put on flecainide approximately 1 month ago.
Previously healthy, taking no medication and exercising regularly. No anginal symptoms asymptomatic during physical exercise. The possibility of an ischemic cause of the ventricular arrhythmia has to be considered! A workup was undertaken in search of a cause of the patient's ventricular arrhythmia. No PVCs are seen.
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