- Regular Tachycardia at a rate of 150/min
- Flutter Waves (circles) at a rate of 300/min best seen in lead II
- Every second flutter wave is conducted, so it’s with 2:1 AV Conduction
- Normal axis
- Normal QRS complexes, ST segments and T waves
What to do ?
Provided the patient is not in heart failure, it is always a good idea to identify the cause of an arrhythmia before treating it. The combination of an atrial arrhythmia, jaundice and splenomegaly suggests alcoholism.
The patient needs anticoagulants, but his INR (international normalized ratio) may already be high. An echocardiogram is needed to assess left ventricular function.
Carotid sinus massage will probably increase the degree of atrioventricular block, but is unlikely to correct the arrhythmia. Digoxin, a beta-blocker or verapamil could be given in an attempt to control the ventricular rate. After anticoagulation, cardioversion – either electrical or with flecainide – will be necessary.
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