Remove Atrial Flutter Remove STEMI Remove Tachycardia
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A 50 year old man with sudden altered mental status and inferior STE. Would you give lytics? Yes, but not because of the ECG!

Dr. Smith's ECG Blog

There is the appearance of STE in inferior leads II, III, and aVF (with STD in aVR), but this is entirely due to flutter waves which are only seen in those leads. Also, the atrial flutter in this case is relatively slow like in many other cases we've shown. Is this inferor STEMI? Tachycardia and ST Elevation.

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Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

Dr. Smith's ECG Blog

The axiom of "type 1 (ACS, plaque rupture) STEMIs are not tachycardic unless they are in cardiogenic shock" is not applicable outside of sinus rhythm. Therefore this patient is either in some form of SVT or atrial flutter. Atrial flutter, when regular, must be conducting at 1:1, 2:1, 3:1, etc.

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A woman in her 60s with large T-waves. Are they hyperacute, hyperkalemic, or something else?

Dr. Smith's ECG Blog

First, we have a narrow-complex, regular tachycardia, with a rate of about 135-140. This narrows our differential for the rhythm down to sinus tachycardia, paroxysmal supraventricular tachycardia (PSVT, or SVT), and atrial flutter. They are flutter waves, and the rhythm is 2:1 atrial flutter.