ECG Case 042

75-year old patient presenting with palpitations. Describe the ECG

TOP 100 ECG QUIZ LITFL 042 2

Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

Main Abnormalities 

This is a typical example of atrial flutter with 2:1 AV block

  • Narrow complex tachycardia at 150 bpm.
  • Sawtooth flutter waves are seen in the inferior leads II, III, aVF.
  • Upright flutter waves in V1 appear either as pseudo-P waves or as notches in the T wave.
  • There is a clear 2:1 relationship between the flutter waves (300 bpm) and QRS complexes (150 bpm).

Inverted flutter waves in lead II.

ECG Flutter waves in II.

Upright flutter waves in V1.

ECG Flutter waves in V1

CLINICAL PEARLS

Tips for Spotting Atrial Flutter

  • Suspect flutter with 2:1 block in any patient with a regular NCT at 150 bpm.
  • Scrutinise leads II and V1 for flutter waves.
  • Flutter waves are typically sawtooth in lead II and resemble P waves in V1.
  • Try turning the ECG upside down — this can make the flutter waves in lead II easier to see.

Inverting the ECG makes flutter waves in lead II easier to see

Invert ECG to enhance flutter waves in Lead II

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 |

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.