20-year old patient with sudden onset of palpitations. What does the ECG show?

TOP 100 ECG QUIZ LITFL 016

Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

Main Abnormalities

Pseudo R’ waves

Pseudo R’ waves


CLINICAL PEARLS

Differential Diagnosis

When you see a regular narrow complex tachycardia at 150 bpm, you should think of four main diagnoses:

The patient’s young age and presence of retrograde P waves (pseudo R’ waves) suggest a paroxysmal reentry tachycardia involving the AV node — either AVNRT (“SVT”) or orthodromic AVRT.

The next step is a therapeutic trial of vagal maneouvres and/or adenosine… (see Quiz ECG 017).


TOP 100 ECG SERIES


Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

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