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  #1  
Old 05-25-2012
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EKG Which Atrial Tachycardia is this?

A 62-year-old man with chronic obstructive pulmonary disease is evaluated in the emergency department for fatigue, dyspnea, anorexia, and nausea. He has a history of mild left ventricular systolic dysfunction and has been treated with an angiotensin-converting enzyme inhibitor and digoxin for approximately 6 months.

Physical examination demonstrates a heart rate of 110/min with some irregularity. Blood pressure is 110/60 mm Hg. The jugular venous pressure is not elevated. There is mild wheezing during expiration. The cardiac examination demonstrates distant heart sounds with some irregularity but no murmurs.

Which Atrial Tachycardia is this?-ekg-001.jpg
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Which of the following is the most likely diagnosis?

A Atrial fibrillation
B Atrial flutter
C Atrial tachycardia with block
D Multifocal atrial tachycardia
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Old 05-25-2012
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D- MAT
>3 p wave morphology in V6 strip rythm and pt had COPD
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Old 05-25-2012
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I must be blind but don't see any P waves
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Why not Digitalis toxicity ? (Ectopic Atrial Tachycardia With Variable AV Block)

Supraventricular Arrhythmias
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  #5  
Old 05-26-2012
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I meant V6 rhythm strip. Though its difficult to recognize the p wave but there are some visible waves at the end of the strip
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Old 05-26-2012
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Ur right if we loook at V1 strip there's actually no conducted p wave
This topic is even worse that diarrhea, Lol
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Old 05-26-2012
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Quote:
Originally Posted by tyagee View Post
A 62-year-old man with chronic obstructive pulmonary disease is evaluated in the emergency department for fatigue, dyspnea, anorexia, and nausea. He has a history of mild left ventricular systolic dysfunction and has been treated with an angiotensin-converting enzyme inhibitor and digoxin for approximately 6 months.

Physical examination demonstrates a heart rate of 110/min with some irregularity. Blood pressure is 110/60 mm Hg. The jugular venous pressure is not elevated. There is mild wheezing during expiration. The cardiac examination demonstrates distant heart sounds with some irregularity but no murmurs.

Attachment 2576
Click image to enlarge

Which of the following is the most likely diagnosis?

A Atrial fibrillation
B Atrial flutter
C Atrial tachycardia with block
D Multifocal atrial tachycardia
-P wave is present but has different form,pt elderly with chronic lung disease=D.
-
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Old 05-26-2012
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Quote:
Originally Posted by Novobiocin View Post
Why not Digitalis toxicity ? (Ectopic Atrial Tachycardia With Variable AV Block)

Supraventricular Arrhythmias
yup this is the answer. how u come to that ? i cant figure it out...please help
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Old 05-26-2012
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look at V1 strip, u see those discrete P wave with nasty shape b/w Qrs, those are not conducted P-waves.
RR intervals are irregular like in MAT, but in MAT we dont found those bizarre shape p wave.
it difficult
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Originally Posted by tyagee View Post
yup this is the answer. how u come to that ? i cant figure it out...please help
I just guessed. This was one of those 50/50 questions ---just pick one and run!
I was trying to look for P waves but could not find many, so I looked in the history ---found pt to be on Digitalis (must be a reason they put Digitalis in the question stem) then i looked again and found that the notch in the T wave in V4 (look at top right) and non-conducting P waves in V5 strip. Searched the web and looked at various ECG's and this was the closest I could find by comparison. Took me an hour though.
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Originally Posted by Novobiocin View Post
I just guessed. This was one of those 50/50 questions ---just pick one and run!
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