Thursday, October 10, 2013

Atrial Flutter with Inferior STEMI?

A 40-something year old male presented with tachycardia.

Computer analysis: Atrial Flutter with Inferior ST Elevation MI.

The computer (and physicians!) frequently fails to recognize that the flutter waves alter the baseline and can thus mimic ST elevation.  All ST elevation in this case is due to the flutter waves.

It is even more common that atrial flutter mimics ST depression.  See this case, and this case.


  1. i admit i can't see flutter waves in v leads, also R-R intervals are not equal best seen in v2. is this right for atrial flutter, sir?

  2. It is definitely atrial flutter. I can see why you are confused: although it is 2:1 conduction, there is some irregularity, which is unusual, but not unheard of. The flutter waves are seen as upright deflections (that appear as upright P-waves) in V1. Every other one is buried in the QRS. Sinus P-waves are almost always biphasic in lead V1. OK?


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