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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. Recently diagnosed with intermittent paroxysmal atrial fibrillation but no EKGs available to confirm.
That volatile course included Atrialflutter 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!
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 is about 130 bpm. The heart rate could be compatible with that of a 2:1 conducted atrialflutter. The ECG below was recorded.
So this is an extremely slow atrialflutter with 2:1 conduction. Atrial rate 146, ventricular rate 73. I suspect that the amyloid slows the conduction of the atrialflutter. It turned out that he had a history of slow atrialflutter. There was no chestpain — and all troponins were negative.
She reports that she is now unable to vagal out of her palpitations and is having shortness of breath and dull chestpain. The differential of a regular narrow QRS tachycardia is sinus tachycardia, SVT, and atrialflutter with regular conduction. Her initial EKG is below.
Check : [vitals, SOB, ChestPain, Ultrasound] If the patient has Abdominal Pain, ChestPain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). Vasovagal predisposition (warm crowded place, prolonged standing, fear, emotion, pain: (-1) 2.
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 chestpain. He said he had had three episodes of chestpain that day while urinating. ECG 1 What do you think? There is a lot going on in this ECG.
Possible but, again, the QRS morphology is atypical 3) AtrialFlutter 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 chestpain, SOB, shoulder pain etc.
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