A woman in her 60s with misdiagnosed palpitations, part 2: Case follow up!

 Written by Pendell MeyersThis post will be follow up information on the patient from this recent case linked below. Make sure to read that one first, then see what happened to this patient in this post below!A woman in her 60s with palpitations, chest discomfort, and multiple misdiagnoses by both EM and Cardiology!!Here is the ECG:Here is the explanation:We see a regular, narrow, monomorphic tachycardia, for which the full differential would include sinus tachycardia, SVT (an umbrella term including many different rhythms), and atrial flutter. This ECG has a large negative atrial wave just before the QRS complexes in the inferior leads, with only one of these waves visible for each QRS complex. These waves are of course fully upright in V1. The differential includes a low ectopic atrial tachycardia near the AV node, or a relatively high AVNRT such that the circuit activates the atrial retrogradely before the circuit can activate the ventricles anterogradely during each lap of the circuit.It is not atrial flutter, because with such a prominent atrial wave seen in the inferior leads we should be able to see a second set of these waves midway between the visible ones.Whatever the atrial waves are, their QRS complexes in the inferior leads are followed by ST segments which seem to be slightly above the baseline in III and aVF. Because I have been fooled by this phenomenon before, and because it does not match OMI patterns I ' ve seen before, I can see that this mo...

Source: Dr. Smith's ECG Blog - October 4, 2021 Category: Cardiology Authors: Pendell Source Type: blogs