ECG Case 017
20-year old patient with sudden onset of palpitations.
What does the rhythm strip demonstrate?
Describe and interpret this ECG
ECG ANSWER and INTERPRETATION
Top rhythm strip
- Regular narrow complex tachycardia
- Pseudo-R’ waves (retrograde P waves) are seen deforming the J point
Middle rhythm strip
- 12mg adenosine given
- A salvo of broad and bizarre-looking complexes interrupts the rhythm (this is a common phenomenon during chemical cardioversion with adenosine)
Bottom rhythm strip
- The patient has reverted to sinus rhythm
- The pseudo-R’ waves have now disappeared
- There are no obvious delta waves of WPW, but this should be confirmed on a 12-lead ECG
CLINICAL PEARLS
The 12-lead ECG confirms reversion to sinus rhythm and does not demonstrate any features of WPW. The diagnosis is AV-nodal reentry tachycardia (AVNRT).
References
Further Reading
- Wiesbauer F, Kühn P. ECG Mastery: Yellow Belt online course. Understand ECG basics. Medmastery
- Wiesbauer F, Kühn P. ECG Mastery: Blue Belt online course: Become an ECG expert. Medmastery
- Kühn P, Houghton A. ECG Mastery: Black Belt Workshop. Advanced ECG interpretation. Medmastery
- Rawshani A. Clinical ECG Interpretation ECG Waves
- Smith SW. Dr Smith’s ECG blog.
- Wiesbauer F. Little Black Book of ECG Secrets. Medmastery PDF
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 FACEM DDU (Emergency) CCPU. Emergency Physician in Melbourne, Australia. Co-Ultrasound Lead for Emergency Medicine at The Alfred Hospital. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor of the LITFL ECG Library.