ECG of the Week – 7th January 2019 – Interpretation

The following ECG is from a 25 yr old female who presented complaining of palpitations for the last hour.


Click to enlarge

Rate:

  • 205 bpm

Rhythm:

  • Regular
  • Nil P waves visible

Axis:

  • Normal

Intervals:

  • QRS – Normal (80ms)

Additional:

  • Diffuse ST depression leads I, II, III, aVF, V2-6
  • ST Elevation leads aVR, V1 & aVL

Interpretation:

  • Regular narrow complex tachycardia
  • ST segment changes likely secondary to high ventricular rate
  • DDx:
    • AVNRT
    • AVRT (orthodromic)

Management 

Management of SVT is dependent on haemodynamic stability, likely underlying cause, facilities / resources available and patient’s wishes.
It usually follows a step-wise approach, assuming no compromise:

  • Vagal maneouvers
  • Adenosine
  • Other drug options
  • DC Cardioversion
  • Simultaneous seek and treat cause – usually absent in most AVNRT
  • Ablation therapy – elective rather than emergent


References / Further Reading

Life in the Fast Lane

Textbook

  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.

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