BEorP Posted November 1, 2012 Posted November 1, 2012 Hey guys, I'm just hoping to get some help with this ECG as I try to get better at reading these. Based on no clear P waves and it being slightly irregular, I want to call it AF. It is also tachy at around 180 though and with how it looks like any attempt at a P wave is often being buried in the T wave, it seems like that would make it more an SVT. Is it possible that this technically is both AF and an SVT? Any help is appreciated!
BEorP Posted November 1, 2012 Author Posted November 1, 2012 It should get bigger if you click on it.
Curiosity Posted November 1, 2012 Posted November 1, 2012 I see Afib with rapid ventricular response.
Sublime Posted November 2, 2012 Posted November 2, 2012 As others have said that looks like A-Fib w/ RVR. And yes... that is technically a form of SVT. SVT = Supra-ventricluar tachycardia. Meaning that the tachycardia is coming from ABOVE the ventricles. So any tachycardic rhythm that originates above the ventricles is an SVT. The term SVT is most often used because many times the rhythm is too fast to discern what the underlying rhythm is.
Kaisu Posted November 3, 2012 Posted November 3, 2012 BEoP if you look at V4 V5 V6 you will see that the rate has slowed enough that the absence of P waves is quite clear. The irregularity is also obvious. Most call this Afib with RVR. I was taught to call it uncontrolled afib. It is helpful to print long rhythm strips in these cases as you will often catch a spot where the rate is slow enough to diagnose. One of the reasons we sometimes administer adenosine is to slow the rate enough to determine what it is. 1
wlittle Posted November 3, 2012 Posted November 3, 2012 Having seen in in the past with patients (I'm retired) and now having it myself, I can say definitely that it's Atrial Fib. The best indicator - for me, at least - was the presence of "saw-teeth" in the EKG. My EKG, prior to the Amiodarone (Paceron) getting my heart back in a normal rhythm, looked that bad and worse. (One of the curses of being EMT, you know when you're in bad shape without the doctor having to tell you.)
Curiosity Posted November 3, 2012 Posted November 3, 2012 Saw tooth P waves is indicative of Aflutter is it not? I don't recall seeing those in Afib.
paramedicmike Posted November 3, 2012 Posted November 3, 2012 The "saw tooth" pattern is typically used to describe the features seen in an atrial flutter tracing. Atrial fibrillation, as referenced previously, is typically described as being irregularly irregular. I agree that the tracing posted is atrial fibrillation with a rapid ventricular response. Kaisu, I'm curious why you were taught to call this uncontrolled a-fib. Simple curiosity question, nothing more.
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