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ECG Blog #409 — Every-Other-Beat.

Ken Grauer, MD

By the P s, Q s, 3 R Approach ( See ECG Blog #185 ): The rhythm is fast and QRS complexes are R egular. PEARL # 4: As emphasized in ECG Blog #204 , in which I review derivation of the bundle branch blocks — RBBB is a terminal conduction delay. ECG Blog #185 — Reviews the P s, Q s, 3 R Approach to Rhythm Interpretation.

Blog 176
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Wide-complex tachycardia that didn’t follow the rules

Dr. Smith's ECG Blog

The WCT is interrupted by a series of variable-morphology QRS complexes, with atrial flutter 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 atrial flutter.

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

Dr. Smith's ECG Blog

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. There appear to be flutter waves at a rate of 300. Flecainide encourages new atrial flutter.

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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

PVCs N ot generally considered abnormal ECG findings: Isolated PAC, First Degree AV Block, Sinus bradycardia at a rate of 35-45, and Nonspecific ST-T abnormalities (even if different from a previous ECG). Thus, if there is documented sinus bradycardia, and no suspicion of high grade AV block, at the time of the syncope, this is very useful.