Tuesday, May 26, 2009

A case of arrhythmia

50-year old male patient came to our hospital complaining of palpitations. He had steted that the onset was about 45 minutes ago and was relater to a fall from a ladder. The patient showed no dyspnea or chest pain. He was not on any medications. There was no signs of distress. His BP was 100/60 and heart rate was 140 bpm and irrregularly irregular. 12-lead ECG was done and here it is:
Click on it to enlarge

What do you thin is the diagnosis and what should we do?

Update: see the tracing after cardioversion below


  1. This is WCT with irregularity mostly SVT with abberation due to Accessory pathway. Provided Patient is hypotensive, and if more,...you should convert him immediately.

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  3. you are right about the accessory pathway. But the rhythm here is atrial fibrillation. The patient was hemodynamically stable but he was converted to sinus rhythm by DC shock. The ECG tracing after cardiversion is provided now in the post.

  4. Well, few days back there came a middle aged lady of around 40 years of age and she was already diagnosed by ECG done outside by a clinician to have PSVT.

    After being given stat dose of 12 mg of Adenosine flush, she was asymptomatic. Though she complained of tingling sensation of the legs just after the flush!

    Was a good experience!


  5. Karem M El TagouryApril 11, 2010 at 9:59 PM

    please determine site of accessory pathway cardiology man?

  6. You are welcomed here Dr Karem,
    Let us take this a step by step. First, determine wheather right, left or septal. I see the V1 showsnegative comples while the R wave is prominant in V2. This make the septal pathway most likely. Then we look at the axis of ventricular activation. It is about 20-30 degrees, i.e to the left and slightly inferior. So, midseptal accessory pathway makes sense here.
    You may find many algorithms using different ideas with variable predective values, So, EPS diagnosis is essential.