This strip shows a supraventricular tachycardia, rate 196 bpm, after adenosine was administered to the patient. The PSVT breaks, and an irregular rhythm composed of sinus beats and premature atrial contractions ensues. This is common after medical cardioversion. The patient later settled into a normal sinus rhythm. The abrupt change from a fast, regular rhythm to a slower, irregular rhythm is evidence that the tachycardia was due to a reentrant circuit, and not sinus tachycardia.
The patient: This ECG was obtained from a two-month-old girl who was a patient in the Emergency Department. She had a fever due to a respiratory infection and was dehydrated. She was alert, active, and irritable.
The ECG: There is a narrow-complex tachycardia at a rate of 194 bpm. This is faster than the normal range for a two-month-old, which is about 80-160 bpm. The intervals are all within normal range. The frontal plane axis, at 145 degrees, is rightward, which is normal for this age. There are prominent, narrow Q waves in the inferior wall leads (II, III, and aVF) and in the left lateral leads (V4, V5, and V6). There are no Q waves in the high lateral leads (I and aVL). This is a normal pattern for this age group. www.sciencedirect.com/science/article/pii/B9781416037743100280
The evaluation of this ECG must be preceded by a thorough evaluation of the patient. SINUS TACHYCARDIA would be expected in the setting of fever, dehydration, hypoxia, pain or other discomfort. Should the rate fail to gradually return to a normal range after treatment, we would have to consider a reentrant supraventricular tachycardia. Reentrant tachycardias have a SUDDEN ONSET and SUDDEN TERMINATION.
Unfortunately, we do not have follow up on the patient.
Dr. Jerry W. Jones, MD, FACEP, FAAEM has graciously shared with us his four-part article on the topic of “Delays & Blocks Involving the Bundle Branches”.
Dr. Jones is a talented instructor who makes difficult topics easy. Please feel free to post your comments and questions for Dr. Jones and our other ECG Gurus.
Click THIS LINK for a downloadable pdf of Part 1: Non-Specific Intraventricular Conduction Delays.
Click THIS LINK for a downloadable pdf of Part 2: Left Bundle Branch Block.
Click THIS LINK for a downloadable pdf of Part 3: Right Bundle Branch Block.
Click THIS LINK for a downloadable pdf of Part 4: The Fascicles of the Left Bundle Branch
Are you looking for a comprehensive ECG glossary that goes beyond simply defining words? Dr. Ken Grauer, who is the ECG Guru's Consulting Expert, has a Glossary available on his website that explains the terms. Instructors and students alike will benefit from having this glossary readily available. The glossary is exerpted from his e-Publication, "A 1st Book On ECGs - 2014", available on Amazon.
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