What do y'all think of this EKG? Healthy, 40 year old male with Covid + in May, recovered, since then has had intermittent fluttering and has Hx or chronic Migraine.
Paroxysmal Atrial Tachycardia versus 2:1 Atrial Fluttler?
given our incomplete understanding of COVID I'd be a bit cautious.
tachycardia and inferior TWI (or biphasic) -- has he got RV strain?
a TTE would be good
Looks like sinus tachycardia to me, but I'd be interested if he's a steady 120 or has variability. Also if you're really unsure you can just give some adenosine and try to slow down the AV node to unveil flutter waves.
V1 P wave morphology is important
" Typical Atrial Flutter (Common, or Type I Atrial Flutter)
Involves the IVC & tricuspid isthmus in the reentry circuit. Can be further classified based on the direction of the reentry circuit (anticlockwise or clockwise):
Anticlockwise Reentry: Commonest form of atrial flutter (90% of cases). Retrograde atrial conduction produces:
Inverted flutter waves in leads II,III, aVF
Positive flutter waves in V1 – may resemble upright P waves
Clockwise Reentry. This uncommon variant produces the opposite pattern:
Im leaning towards sinus tach and the problem is not in the T waves. P waves seem P wave pulmonale in some leads. I have seen this a bunch of times in CoViD patients.
Eg. Hypoxic pulm vasoconstriction, increased PA pressures etc etc
OR
Needs of diuretics
#my2cents