The following ECG is from a 70yr old who presented with lethargy. Past medical history of Aortic Valve Replacement with post operative AF. Vital signs: BP 85/60 RR 18 Sats 94% (Room Air). Check out the comments from our original post here.
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- Mean ventricular rate bpm
- Atrial rate ~300 bpm
- Atrial flutter with variable high grade block (4:1 --> 10:1)
- ST Depression leads V3-4 likely secondary to superimposed flutter waves
- 'Saw tooth' baseline appearance
- Flutter waves - negative in inferior leads and positive in V1
- Atrial flutter
- Typical counter-clockwise
- High grade variable block
What happened ?
Following discussion with the patient's cardiologist they were DC cardioverted with reversion to sinus rhythm and improvement in heart rate to 60-70 bpm.
More information on flutter classification / types:
Both papers provide in-depth reviews of atrial flutter classifications, both new & old, and how the ECG and advanced EP techniques can help differentiate themReferences / Further Reading
Life in the Fast LaneTextbook
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.