What is the most likely diagnosis based on the ECG findings?
Anonymous Poll
26%
AVNRT (PSVT)
54%
Atrial flutter
11%
Atrial tachycardia
9%
Atrial fibrillation
ECG features:
• Narrow complex tachycardia at ~160 bpm.
• Sawtooth flutter waves are seen best in the inferior leads (II, III, and aVF)
• There is a clear 2:1 relationship between the flutter waves (~320 bpm) and QRS complexes (~160 bpm).
• Narrow complex tachycardia at ~160 bpm.
• Sawtooth flutter waves are seen best in the inferior leads (II, III, and aVF)
• There is a clear 2:1 relationship between the flutter waves (~320 bpm) and QRS complexes (~160 bpm).
Which of following coronary arteries is most likely involved in this patient?
Anonymous Poll
54%
Left anterior descending artery (LAD)
11%
Left circumflex artery (LCX)
17%
Right coronary artery (RCA)
17%
Left main coronary artery (LMCA)
The ECG shows upslope ST-Depressions and peaked T waves in the anterior leads. this pattern is called “De Winter T wave” and seen in ~2% of acute LAD occlusions.
What is the most likely diagnosis?
Anonymous Poll
52%
Acute myocardial infarction complicated by Ventricular tachycardia
7%
Sinus tachycardia and massive myocardial infarction
17%
Atrial fibrillation with LBBB
23%
Hyperkalemia
The correct answer is “Acute myocardial infarction complicated by Ventricular tachycardia”
• The ECG shows a wide complex tachycardia at a rate of ~175 bpm. Although the rhythm is irregular, there are findings that suggest ventricular tachycardia (VT); Most notably AV dissociation (P waves are shown with arrows). As you see, there is no relationship between P waves and QRS complexes. Note that VT may be irregular in particular at the beginning.
• STT changes are common findings in any rhythm with wide QRS complexes including VT, However, despite secondary STT changes, there are concordant ST-elevations (ST-elevations in leads with positive QRS complexes) in leads 1, aVL and V6 which suggest acute myocardial infarction (MI). The next ECG is taken after the patient got cardioversion shock and confirms anterolateral MI.
• STT changes are common findings in any rhythm with wide QRS complexes including VT, However, despite secondary STT changes, there are concordant ST-elevations (ST-elevations in leads with positive QRS complexes) in leads 1, aVL and V6 which suggest acute myocardial infarction (MI). The next ECG is taken after the patient got cardioversion shock and confirms anterolateral MI.