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A young woman with palpitations. What med is she on? With what medication is she non-compliant? What management?

Dr. Smith's ECG Blog

Atrial flutter with 2:1 conduction. The atrial flutter 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 atrial flutter soon after her aortic surgery, and was put on flecainide approximately 1 month ago.

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Syncope while on a treadmill

Dr. Smith's ECG Blog

To me, it was clearly atrial flutter with 1:1 conduction. The rate of 280 is just right for atrial flutter. The waves look like atrial flutter waves, NOT like a wide ventricular complex. Because the patient was exercising, which increases sympathetic tone, facilitating AV conduction.

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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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A young man with tachycardia. Should We Try Adenosine?

Dr. Smith's ECG Blog

Sinus tach will rarely remain exactly constant, while PSVT or flutter will always have the same re-entrant rate 2. See many cases with use of Lewis Leads on this blog: Case continued The providers jumped to conclusions and gave adenosine. Try Lewis Leads. This is using the Monitor leads, not the 12-lead electrodes!

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Young Man with a Heart Rate of 257. What is it and how to manage?

Dr. Smith's ECG Blog

The Differential Diagnosis is: SVT with aberrancy(#) [AVNRT vs. WPW (also called AVRT*)] Atrial flutter 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.