Submitted by Dr A Röschl on Tue, 07/30/2024 - 03:13
The first 3 beats are sinus node beats, all have the same morphology of the P wave. This is followed by a PAC, which is conducted via the fast pathway in the AV node. The next PAC is conducted via the slow pathway, then the AV nodal reentry tachycardia (slow/fast) starts. The retrograde P waves are visible at the end of the QRS complex in the lower lead K3.
Submitted by Dr A Röschl on Wed, 09/13/2023 - 04:01
18-year-old male; palpitations lasting hours, beginning at the age of 10. What arrhythmia is present? Let's first consider the heart rate: with a heart rate of 194 beats/min, the heart rate is too low for atrial flutter (1:1) (except in patients who have been pre-treated with medication), and the rate would be unusually high for atrial flutter with 2:1 conduction. Due to the regularity of the heart rhythm, atrial fibrillation can also be ruled out. This leaves atrial tachycardia, junctional tachycardia, AVNRT, and AVRT as possibilities.
