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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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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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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.
 

MirrorTodd

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My cards buddy thinks its Flutter with poor R wave progression. Says I need a "high quality ECG" to tell PAT from Aflutter.
Is that some special type of ekg or just telling the tech to actually run the study when the pt isn't moving around and talking?
 
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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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