The following ECG is from an 81yr old female who presented with a 48hr history of palpitations. She underwent a cardioversion for an atrial arrhythmia 1 year ago. Her medications include metoprolol, digoxin and eliquis.
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- 132 bpm
- Possible atrial activity seen in leads I, II, III and aVF
- Lead II suggests inverted small atrial waves seen with ST segment and T-QRS interval
- QRS – Normal
- ST Elevation lead aVR
- ST Depression leads II, III, aVF, V4-6
- Likely to reflect rate related demand changes and superimposed atrial activity
- Regular narrow complex tachycardia
- Atrial flutter with 2:1 block – favoured due to the patient’s history of AF
- Atrial tachycardia with 2:1 block
What happened ?
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.
References / Further Reading
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.