#case196 ❤️

55 y man with history of mitral valve replacement presented with palpitation

The correct answer is “Atrial flutter”

ECG features:
• Inverted flutter waves in Inferior leads at a rate of 350 bpm
• Upright flutter waves in V1 simulating P waves
• 2:1 AV block resulting in a ventricular rate of 175 bpm

55 y man with history of Ischemic heart disease presented with occasional dizziness.

The correct answer is “Second degree AVB: mobitz 1 (Wenckebach)”

ECG features:
• QRS complexes cluster into groups, separated by short pauses. At the end of each group is a non-conducted P wave (dropped beats)
• The PR interval progressively increases from one complex to the next.
• The P-P interval is relatively constant despite the irregularity of the QRS complexes.

65 y female with history of heart failure presented with palpitation

The correct answer is “Atrioventricular nodal reentry tachycardia (AVNRT)”

In the beginning, there are sinus beats that are conducted with 1st degree AV block. These beats are followed by ectopic atrial contractions which are not conducted through AV node (blocked PACs). However, an ectopic atrial contraction eventually triggers an AVNRT, a regular narrow complex tachycardia with relatively long RP intervals due to slow conduction through retrograde pathway in the AV node.

Special Thanks to my dear friend salvatore salvatore for providing the diagram.

#case199 ❤️