This scared me at first

[Vodcox]

I want to know some oppinions on what this rhythm is.

CC: Resp. Diff. - 86 y/o F.

[emt322632]

I want to know some oppinions on what this rhythm is.

CC: Resp. Diff. - 86 y/o F.

It looks to be sinus tach with ST depression and T wave inversion, possibly indicative of ischemia. See a few PVCs in their too, but too much of a wandering baseline and can't really tell from the photo if it's regular or not, could you scan it instead of photographing it?

[TheOldMan]

Please try to include the 12 lead measurements, pr interval, qrs duration. Could be a LBBB, then is it a new BBB or existing?

[crotchitymedic1986]

Sinus Tach, pt is probably on digoxin -- no biggie

[Mateo_1387]

I am seeing sinus tach with biventricular hypertrophy and biventricular strain pattern.

[fiznat]

Holy hypertrophy!

-Looks like we have a regular, wide-complex tachycardia at a rate of about 150 with the occasional (probably ventricular) ectopy.

-There appear to be P-waves of consistent morphology and a regular PR interval.

-The mean QRS axis is within the normal range and R wave progression through the anterior leads is good.

This is likely an atrial tachycardia with LBBB abbarancy. The standout part of the ECG though is definitely the huge QRS amplitude, which is probably due to hypertrophy. Both the left bundle and the hypertrophy are factors that mess with the ST segment, so this ECG is non-diagnostic for ischemia/infarct without more info from the story/presentation.

What kind of machine printed that 12 lead by the way? Its weird.

Edited March 18, 2009 by fiznat

[27yrsinthebiz]

I want to know some oppinions on what this rhythm is.

CC: Resp. Diff. - 86 y/o F.

Clearly it is A-Fib with a rapid ventricular response. From what I can see, the QRS interval is within normal limits, that and your axis is normal which rules out a left bundle branch block with aberant conduction. The best thing I can come up with based on what I can see is A-Fib with a rapid ventricular response and left ventricular hypertrophy. The hypertrophy would present with inverted ST segements, especially in AvL, V-5, V-6,, which your strip has. I don't see anything malignant here other than the rate.

[Vodcox]

Holy hypertrophy!

-Looks like we have a regular, wide-complex tachycardia at a rate of about 150 with the occasional (probably ventricular) ectopy.

-There appear to be P-waves of consistent morphology and a regular PR interval.

-The mean QRS axis is within the normal range and R wave progression through the anterior leads is good.

This is likely an atrial tachycardia with LBBB abbarancy. The standout part of the ECG though is definitely the huge QRS amplitude, which is probably due to hypertrophy. Both the left bundle and the hypertrophy are factors that mess with the ST segment, so this ECG is non-diagnostic for ischemia/infarct without more info from the story/presentation.

What kind of machine printed that 12 lead by the way? Its weird.

It is a Phillips monitor, not sure of the exact model

[crotchitymedic1986]

Clearly it is A-Fib with a rapid ventricular response. From what I can see, the QRS interval is within normal limits, that and your axis is normal which rules out a left bundle branch block with aberant conduction. The best thing I can come up with based on what I can see is A-Fib with a rapid ventricular response and left ventricular hypertrophy. The hypertrophy would present with inverted ST segements, especially in AvL, V-5, V-6,, which your strip has. I don't see anything malignant here other than the rate.

What are you smoking ? AFIB ? hope you were joking. Regular Rhythm, p waves before every complex.

[fiznat]

Clearly it is A-Fib with a rapid ventricular response. From what I can see, the QRS interval is within normal limits, that and your axis is normal which rules out a left bundle branch block with aberant conduction. The best thing I can come up with based on what I can see is A-Fib with a rapid ventricular response and left ventricular hypertrophy.

Ah, what?

This is definitely not a-fib. There are clear p waves preceding each QRS and the rhythm is without a doubt regular. Let me show you:

The red lines indicating the R-R interval are all of the exact same length (they are cut + paste versions of each other). The short red lines are underlining the p waves.

Also, the QRS is likely wide, although I admit it is difficult to tell exactly since we can't see the small boxes very well. If it isn't wide then it is close to wide, which qualifies for an incomplete LBBB at the least. While an axis deviation is sometimes seen in the presence of left bundles, it certainly is not an absolute criteria nor a rule-out. Remember LVH is supposed to cause a left axis as well, but there is definitely LVH in this ECG. The normal axis doesn't rule out anything.