EKG

your vote counts twice

Just picture yourself in turn-of-the-century Chicago.

Always look at the computer read of an EKG, you need to know and recognize what it’s “seeing.”  However, you should never rely on it.  On to this week’s EKG…

20171113_
~70 y.o. man with orthopnea, increased lower extremity edema, vague chest discomfort, and shortness of breath.

Rate:  nearly bang-on 150.  That right there should cause your to perk your ears up that this is A flutter.  The computer calls it a wide-complex tachycardia presumably because of the QRS’s in the inferior leads.  What is the rhythm though.  There are the suggestion of P waves in the early chest leads, but the heart rate if nothing else should trigger us to specifically look for flutter leads.  Where are flutter waves best seen? Inferiorly.  What do we see looking inferiorly?  Those sure look like flutter waves do they not?

Looking at the QRS I would honestly call it narrow.  That being said there is an odd terminal slurring of the QRS in the chest leads which is what the computer is identifying as non-specific intraventricular conduction delay.    I don’t find the T waves that remarkable, I would say that the lateral chest leads are flattened somewhat, presumably caused by the A Flutter with RVR and CHF.  The computer interpretation of inferior ischemia is the flutter waves.

People were fairly successful with this EKG.  We did a similar one a few months ago.  The first take-home is to always make an objective assessment of the EKG without relying upon the computer interpretation.  The other is that heart rates of 150 are frequently 2:1 flutter, look at those inferior leads carefully with that heart rate.

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