EKG help

chocomorsel

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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?
 

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dipriMAN

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Not sure, could just be sinus tachycardia with a biphasic t wave in lead II making it look funny.
 
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dipriMAN

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Have heard of several patients developing heart block in acute Covid infections.
 
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Choo

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flutter in II, III, and aVF
 
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Ronin786

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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:

  • Positive flutter waves in leads II, III, aVF
  • Broad, inverted flutter waves in V1"
 
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vector2

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Looks like sinus tach with biphasic T waves in the inferior leads


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vector2

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It is paroxysmal and no one tried any vagal maneuvers to slow it down. It popped back to NSR on its own.

You have a NSR ekg for comparison?


Man, if that's 2:1 flutter then I'm just gonna resign myself to missing it 100% of the time unless the ventricular rate is 150 bpm
 
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chocomorsel

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You have a NSR ekg for comparison?


Man, if that's 2:1 flutter then I'm just gonna resign myself to missing it 100% of the time unless the ventricular rate is 150 bpm
My cards buddy thinks its Flutter with poor R wave progression. Says I need a "high quality ECG" to tell PAT from Aflutter.
 

Lidolover

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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
 
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Hork Bajir

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Looks like sinus tach to me. Could you ask your cards buddy what about this makes it PAT vs AFlutter?
 
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