We originally published this ECG in 2012. It was generously donated to the ECG Guru website by our friend and ECG Guru Extraordinaire, Jason Roediger. We are re-publishing it today, as it is a great ECG for illustrating how helpful laddergrams can be for showing conduction in dysrhythmias.
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.
Wide-QRS rhythms can be difficult to diagnose from the ECG alone. This difficulty is compounded when the rate is fast, as it can be hard to determine if P waves are present before the QRSs, or dissociated, or absent.
This ECG and rhythm strip were donated to the ECG Guru by Ryan Cihowiak. We don't have clinical information on the patient, unfortunately. It is a great example, however, of how difficult WCT can be to diagnose.
Today, you get THREE strips for your basic classes! The first shows a PSVT - paroxysmal supraventricular tachycardia at a rate of about 220/minute. The QRS complexes are narrow, and the rhythm is regular. In the second strip, we see the moment of conversion after a dose of 6 mg. of adenosine was administered by rapid I.V. infusion. The re-entry cycle is broken, and the patient experiences many PVCs, including groups of two, three, and even four in a row. Soon, however, the rhythm settles into sinus rhythm with PACs, and later, just sinus rhythm (not shown).
This ECG was presented earlier this week as an example of SVT with LBBB aberrancy, which was ultimately converted with one dose of adenosine in the Emergency Department. It is the most shared and commented on ECG yet to appear on the Guru. The diagnosis given was the one accepted by the medical staff who cared for the patient, who was a man in his 30's who presented to the Emergency Department complaining of a rapid heart rate. He was ambulatory with stable vital signs, in spite of the tachycardia.
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