EKG help

[chocomorsel]

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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[MirrorTodd]

How much hydroxychloroquine did he get?

 

[deleted875186]

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

 

[deleted875186]

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

 

[Choo]

flutter in II, III, and aVF

 

[dhb]

flutter in II, III, and aVF

Proceed in I and V1-V6, avoid hypoxia, hypotension and tachycardia.

 

[deleted59964]

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

what's the case?
things like this ... https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31182-X/fulltext ... are concerning

 

[dhb]

Maybe i suck balls but i only see a sinus rhythm.

 

[chocomorsel]

This is not a surgical case. It’s a floor IM case.

 

[DocMcCoy]

Man, I’m no expert either but I’m not convinced this isn’t sinus tach??? Seems a little slow for 2:1 flutter

 

[Ronin786]

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"

Atrial Flutter

Atrial flutter is a type of supraventricular tachycardia caused by a re-entry circuit within the right atrium

litfl.com

 

[Ronin786]

flutter in II, III, and aVF

Are you sure those aren't just inverted T waves? The QT interval is the same in II/III/aVF and Lead 1

 

[vector2]

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

 

[chocomorsel]

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

 

[BlueRug]

looks like sinus tach....any PE concerns?

 

[vector2]

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

 

[chocomorsel]

looks like sinus tach....any PE concerns?

No PE concerns. Back in SR now and doing fine. SOB with the abn. rhythm resolving after return to normal sinus..

 

[chocomorsel]

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]

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?

 

[chocomorsel]

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?

I have no earthly idea. Had to ask him and waiting on a response. Never heard of that.

 

[Ronin786]

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

It's also slower than what you'd expect out of Aflutter.

 

[Lidolover]

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

 

[Hork Bajir]

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

 

[deleted875186]

I’ve changed my mind. Definitely look like flutter waves or some sort of SVT.

 

[Planktonmd]

Sinus tachycardia. Let's not complicate life.