This ECG is from a man in his 60's who is experiencing chest discomfort and palpitations. The onset of the rapid heart rate and the symptoms was sudden, while he was at rest. The rate did not slow when he was placed on oxygen, given IV fluids, and rested further
This series of ECG rhythm strips shows a paroxysmal supraventricular tachycardia successfully treated with adenosine. The patient was complaining of a rapid heart rate and palpitations, but was hemodynamically stable. It is not known whether any parasympathetic stimulation, such as a Valsalva maneuver or carotid sinus massage, was used initially.
This ECG shows AV nodal reentrant tachycardia in an elderly man. Clinical information is not available. AVNRT is the rhythm most often associated with the term, "supraventricular tachycardia".
This two-lead rhythm strip clearly shows the transition from normal sinus rhythm to a paroxysmal supraventricular rhythm. In this case, the arrhythmia is AV nodal reentrant tachycardia, AVNRT. The rate of the first rhythm, NSR, is around 75 per minute. The fourth beat on the strip is a PAC which initiates the paroxysm of tachycardia lasting 12 beats. The arrhythmia terminates spontaneously at that point. The tachycardia rate is about 150/min.
This example of supraventricular tachycardia is from a 51-year-old woman who presented to the Emergency Dept. with a complaint of palpitations. We do not have any more clinical information for her. We know this tachycardia is supraventricular because the QRS complexes are narrow. The term, "supraventricular tachycardia", or "SVT" actually describes many different rhythms with many different mechanisms and causes. It would help a great deal to see the beginning (or end) of this rhythm to determine if the onset was sudden (paroxysmal) - or gradual.
This strip is from a patient who experienced a sudden onset of palpitations and rapid pulse while at rest. It shows a narrow-complex tachycardia, specifically a paroxysmal supraventricular tachycardia. The subject of supraventricular tachycardias is a fascinating one, and is covered extensively throughout this website. The mechanisms of SVT are many, and can be complex for the beginning student to understand. Search the search terms on the left side of the page for entries from ASK the EXPERT and JASON's BLOG for more advanced information about SVT.
Jason is taking a break (everyone needs one now and then). April's ECG will appear through May, as well. It's a good one!
Patient clinical data: 68-year-old black man.
(1.) What "pseudo" clue in Fig. 1 clinches the source of the mechanism seen in Fig. 2?
Our expert today is Dr. Ken Grauer. He is a frequent contributer to the ECG Guru.
KEN GRAUER, MD is Professor Emeritus (Dept. Community Health/Family Medicine, College of Medicine, University of Florida in Gainesville).
Dr. Grauer has been a leading family physician educator for over 30 years. During that time he has published (as principal author) more than 10 books and numerous study aids on the topics of ECG interpretation, cardiac arrhythmias, and ACLS (including an ongoing Educational ECG Blog.
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