This post is an answer to the ECG Case 323
- Rate: 132 bpm
- Rhythm:
- Regular
- Possible atrial activity seen in leads I, II, III and aVF
- Lead II shows inverted small atrial waves seen within ST segment and T-QRS interval
- Axis: Normal
- Intervals: QRS – Normal
- Additional:
- ST Elevation in lead aVR
- ST Depression in leads II, III, aVF, V4-6
- Likely to reflect rate related demand changes and superimposed atrial activity
Interpretation
Regular narrow complex tachycardia. Differentials:
- Atrial flutter with 2:1 block – favored due to the patient’s history of AF
- Atrial tachycardia with 2:1 block
What happened next ?
Following screening for acute electrolyte disturbance, non-cardiac precipitant, drug toxicity and ensuring compliance with coagulation regime the patient underwent an uneventful DC cardioversion under procedural sedation.
READ MORE: Atrial Flutter: ECG Interpretation [With Examples]
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