![]() ![]() Atrial flutter might be diagnosed using an an electrocardiogram (EKG). In atrial flutter, a problem with the heart’s electrical system causes the two upper parts of the heart (the right atrium and the left atrium) to flutter, or beat very fast. Normally, the heart beats in a strong, steady rhythm. This fast rate is caused by changes in the electrical system of your heart. aVL: true + vs.Atrial flutter is a type of heartbeat problem (arrhythmia) that usually causes a fast heart rate. ![]() Atrial Repolarization Wave with Additional Ischemic ST Depression (1).Atrial fibrillation-conversion to sinus (1).atrial fibrillation with slow ventricular response (1).Atrial Fibrillation with RVR exaggerates ST Elevation (1).atrial fibrillation with RVR - primary instability (1).Atrial Fibrillation RVR due to Secondary condition (2).Arrhythmogenic Right ventricular dysplasia (2).Arrhythmogenic Right Ventricular Cardiomyopathy (3).Appropriate Discordance in LBBB and Paced Rhythm (1).Antiplatelet Therapy for UA/NonSTEMI (1).Anti-dysrhythmics in STEMI w cardiac arrest/ventricular fibrillation (1).Anterior STEMI with minimal ST elevation less than 1 mm (11).Angiography in ROSC shockable rhythms (1).10 cases examples of lateral hyperacute T-waves V4-V6 (2).Smith EKG lectures next year (2017).Schedule.A patient with a ventricular paced rhythm and ches.Sepsis with Pulmonary Edema and Elevated Right Sid.RSR' with ST elevation: is this Right Bundle Branc.Is this STEMI? LVH? Early Repolarization?.An apparent SVT that does not persistently correct.Consider hyperkalemia.Ĭonsider reversible causes (especially hyperkalemia or drug effect from beta blockers or calcium channel blockers before pacing). The long ST segment is probably due to hypocalcemia. ![]() There is only the automatic escape, and it originates from the posterior fascicle.ĭiagnosis: Atrial Flutter with complete, third degree, AV block. In this case, there is no supraventricular stimulus. Thus, RBBB + LAFB also, in a sense, originates from the posterior fascicle. When there is a supraventricular rhythm with RBBB and LAFB, the impulse gets to the posterior fascicle only, then spreads to the ventricle from the posterior fascicle. Then why the RBBB and LAFB morphology? Because the escape is originating in the posterior fascicle. Much more likely is that this is a ventricular escape. Is it a junctional escape? A junctional escape should be around a rate of 40, and it should be narrow, unless there is a junctional escape + RBBB + LAFB. So this is atrial flutter with complete AV block and a regular escape rhythm. Instead, there is a very regular escape rhythm If you look closely, this does not happen: Every time the flutter circuit goes around the atrium it arrives at the AV node at the same part of the wave and, if the AV node is ready to conduct, that is when it conducts. How do I know? When atrial flutter conducts, the QRS should occur at the same part of the flutter wave for every QRS. Instead, there is third degree (complete) AV block. This is not Flutter with 7 or 8 to 1 conduction. The flutter waves are not conducting through the AV node. There is also a very long QT, primarily due to a long ST segment The QRS has the morphology of Right Bundle Branch Block (RBBB) and Left Anterior Fascicular Block (LAFB) A 50-something presented with bradycardia. ![]()
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