EKG Case 2

73 year old male come to the ED with c/o palpitations. The 12 lead EKG is shown as follows. What rhythm do you notice on the strips.



Answer: Atrial Flutter

(Source: Amal Mattu EKG Case, Sept 11, 2011.)

Take Home Points:
The most common misdaignosed rhythm on EKG Strips.
Regular, Narrow QRS: look for Sinus Tachy, SVT, Atrial Flutter

Consider Atrial Flutter: Ventricular rate 150 + 20
Look at all 13 leads in the EKG
Sinus Tachy cannot go on for long hours at same rate.
Most often lead V1 will show us the best view of P waves when other leads do not help.
P waves my be upside down, turn the EKG upside down and now view it.
The other trick is change the speed of EKG recording to 50 mm/sec, this would stretch the rhythm strip and make Ps more prominent.