- Narrow complex tachycardia, rate about 230/min
- No P waves
- Normal axis
- Normal QRS complexes
- ST segment depression in all leads except aVR and V1
- ST segment elevation in leads aVT and V1
Narrow complex tachycardia without P waves – atrioventricular nodal re-entry (junctional) tachycardia (AVNRT).
There’s also global ST segment depression with reciprocal ST elevation in leads aVR and V1 indicating subendocardial ischemia caused by supply-demand mismatch probably because of underlying coronary artery disease in this patient.
What to do ?
Not all patients with a paroxysmal tachycardia complain of palpitations; this patient’s recurrent chest pain may well have been due to this arrhythmia. He should be taught the methods of inducing vagal activity, but prophylactic drug therapy will be needed: a beta-blocker or verapamil should be tried first.
Electrophysiological investigation, with a view to ablating an abnormal pathway, may be needed. Also he should be investigated for underlying coronary artery disease.