EKG of the Week

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This EKG was done on routine office visit when a 72 year old patient noted to be tachycardic, they were asymptomatic.

+ EKG Interpretation

Dr. Ohlbaum's Explanation

The computer read this as sinus tach. What do you think?

Well, it is fast, and it is regular and it is a narrow QRS. The patient is 72 so his maximum SINUS rate is in 140s (220-age) and he is not on a treadmill so, immediately, this seems quite fast for a resting ekg. Are there P waves? Again, at first glance there is a “something” before the QRS but when you look more closely that same “something” can also be seen at the end of the QRS, and those 2 things march through the whole ekg at rate ~270. Those are not P waves they are flutter waves.

This is atrial flutter with 2:1 block. The computer will often miss this.

The QRS is big, does he have LVH? My favorite quick criteria, is r>11 in avl, so yes. And an extreme left axis (isoelectric in avr so about minus 60) with big S in the inferior leads and less than usual R wave progression consistent with a left anterior fascicular block (left anterior hemiblock).

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