tag:blogger.com,1999:blog-549949223388475481.post5765040044799816551..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Atrial Flutter Mimicking ST DepressionUnknownnoreply@blogger.comBlogger3125tag:blogger.com,1999:blog-549949223388475481.post-24334085649714264342020-12-07T06:40:26.945-06:002020-12-07T06:40:26.945-06:00Great Post! The Systematic Approach "Watch yo...Great Post! The Systematic Approach "Watch your Ps, Qs and the 3 Rs" is useful. The rhythm in first ECG is a regular SVT (Narrow & Regular/SupraVentricular Tachycardia) at ~130/minute without clear sign of sinus P waves. The pattern of ST segment deviation that we see here (ie, ST depression in no less than 7 leads — with ST elevation in aVR & V1-3) is suggestive of subendocardial ischemia. There is LVH(deep S wave in V1 ~28 mm and 30 mm in V2). As per Ken KEN GRAUER the principal differential diagnosis of a regular SVT without clear sign of sinus P waves includes: i) Sinus Tachycardia; ii) Reentry SVT (either AVNRT if the reentry circuit is contained within the normal AV nodal pathway — or AVRT if an accessory pathway is involved); iii) Atrial Tachycardia; or iv) Atrial Flutter. Regularly occurring peak to peak or valley to valley of the flutter waves would be easily appreciated in lead V1 and lead II respectively in Aflutter, but I can't see this in first ECG.I want to know why isn't the other(such as AVNRT or AVRT; Atrial Tachycardia)?. Why AFlutter? Thanks A LOT.O Poder da Eletrocardiografiahttps://www.blogger.com/profile/11143192155299060176noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-8297835714481336362017-12-02T07:40:34.203-06:002017-12-02T07:40:34.203-06:00Martin,
good point. It is atypical.
It's possi...Martin,<br />good point. It is atypical.<br />It's possibly a non-sinus atrial rhythm.<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-14144219229309173292017-12-01T20:08:08.491-06:002017-12-01T20:08:08.491-06:00Dr. Smith,
the P Wave in Sinus is really upright,...Dr. Smith, <br />the P Wave in Sinus is really upright, but also in II, III there its somewhat biphasic and in aVR slight positiv, isnt it somewhat atypical for Sinus??Anonymoushttps://www.blogger.com/profile/04108355159375143998noreply@blogger.com