Dr. Smith's ECG Blog

JULY 14, 2023

That volatile course included Atrial flutter with RVR: == MY Comment , by K EN G RAUER, MD ( 7/11 /2023 ): == It's always rewarding to get "a Save!" — as in today's case, in which this 40-something year old patient with persistent VFib, followed by an extended complicated course — ultimately survived with intact neurologic status!

Cardiac Arrest 98

Cardiac Arrest Chest Pain Defibrillator Atrial Flutter 98

Circulation: Arrhythmia and Electrophysiology

DECEMBER 21, 2023

Colchicine did not prevent atrial arrhythmia recurrence at 2 weeks (31% versus 32%; hazard ratio [HR], 0.98 [95% CI, 0.59–1.61];P=0.92) Postablation chest pain consistent with pericarditis was reduced with colchicine (4% versus 15%; HR, 0.26 [95% CI, 0.09–0.77];P=0.02) mg twice daily or placebo for 10 days. 2.02];P=0.89).

Atrial Fibrillation 40

Atrial Fibrillation Ablation Chest Pain Atrial Flutter 40

Dr. Smith's ECG Blog

JULY 16, 2024

This is the prehospital ECG from an 81 year old man with acute chest pain. There are 2 atrial "bumps" for every QRS. Here I put arrows: Arrows shows slow atrial flutter waves. And — it may be that this 81-year old man's "chest pain" may also disappear as soon as normal sinus rhythm is reestablished.

Atrial Flutter 59

Atrial Flutter Chest Pain Tachycardia Arrhythmia 59

Dr. Smith's ECG Blog

JANUARY 9, 2024

She presented to the emergency department after a couple of days of chest discomfort. The ECG was interpreted as showing atrial flutter with 2:1 conduction. The heart rate could be compatible with that of a 2:1 conducted atrial flutter. Also, lead I could give the initial impression of showing flutter waves.

Tachycardia 120

Tachycardia Electrophysiology Atrial Flutter Ischemia 120

Dr. Smith's ECG Blog

NOVEMBER 15, 2020

So this is an extremely slow atrial flutter with 2:1 conduction. Atrial rate 146, ventricular rate 73. I suspect that the amyloid slows the conduction of the atrial flutter. It turned out that he had a history of slow atrial flutter. There was no chest pain — and all troponins were negative.

Atrial Flutter 52

Atrial Flutter Cardiomyopathy Chest Pain Arrhythmia 52

Dr. Smith's ECG Blog

OCTOBER 25, 2022

She reports that she is now unable to vagal out of her palpitations and is having shortness of breath and dull chest pain. The differential of a regular narrow QRS tachycardia is sinus tachycardia, SVT, and atrial flutter with regular conduction. Her initial EKG is below.

Tachycardia 52

Tachycardia Atrial Flutter Dysrhythmia Ablation 52

Dr. Smith's ECG Blog

JUNE 27, 2021

A 50-something man with history only of alcohol abuse and hypertension (not on meds) presented with sudden left chest pain, sharp, radiating down left arm, cramping, that waxes and wanes but never goes completely away. 2 months later, he presented in pulmonary edema with atrial flutter and formal echo had EF 20% Why did this happen?

Myocardial Infarction 40

Myocardial Infarction Ischemia STEMI Pulmonary 40

Dr. Smith's ECG Blog

JANUARY 5, 2020

This 60-something with h/o COPD and HFrEF (EF 25%) presented with SOB and chest pain. M Y A NSWER: In my experience, MAT is the 2nd-most commonly overlooked cardiac arrhythmia ( surpassed only by Atrial Flutter ). The patient in this case presented with dyspnea and chest pain.

Atrial Fibrillation 52

Atrial Fibrillation Tachycardia Arrhythmia Pulmonary 52

Dr. Smith's ECG Blog

FEBRUARY 9, 2024

Written by Jesse McLaren A 65 year old with a history of atrial flutter, CABG and end-stage renal disease on dialysis presented with 3 days of fluctuating chest pain, which was ongoing at triage. So a patient with high pretest probability (prior CABG with new chest pain), had new ECG changes showing posterior OMI.

Chest Pain 115

Chest Pain STEMI Atrial Flutter Ischemia 115

Dr. Smith's ECG Blog

MARCH 6, 2020

This middle-aged man with no cardiac history but with significant history of methamphetamin and alcohol use presented with chest pain and SOB, worsening over days, with orthopnea. There is atrial activity before every QRS, but that activity has negative polarity, so it is not sinus rhythm. The other atrial flutter types are: 1.

Heart Failure 52

Heart Failure Tachycardia Atrial Flutter Cardiomyopathy 52

Dr. Smith's ECG Blog

DECEMBER 20, 2024

Written by Willy Frick with edits by Ken Grauer An older man with a history of non-ischemic HFrEF s/p CRT and mild coronary artery disease presented with chest pain. He said he had had three episodes of chest pain that day while urinating. ECG 1 What do you think? There is a lot going on in this ECG.

Chest Pain 102

Chest Pain Tachycardia Pacemaker Defibrillator 102

Dr. Smith's ECG Blog

APRIL 8, 2015

Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade.

Arrhythmia 52

Arrhythmia Outcomes Risk Factors Chest Pain 52

Dr. Smith's ECG Blog

MARCH 6, 2025

Possible but, again, the QRS morphology is atypical 3) Atrial Flutter with 2:1 conduction and "aberrancy". I do not see flutter wave baseline, and again the QRS morphology is not typical for a supraventricular rhythm. With OMI, all you know is that your patient has some nonspecific chest pain, SOB, shoulder pain etc.

Tachycardia 96

Tachycardia Dysrhythmia ICU Pulmonary 96