ECG Question

[step_enhancer]

A 66 year old man comes for a routine check up ,he feels well apart from occasional cough which he tells, he is use to from a long time . He drinks alcohol 2 beers in weekends and he smokes a pack of cigarette since 30 years.He was recently vaccinated for influenza and pneumococcus.He admits of feeling fatigue at times ,but blames it to his age.He gives a history of an angina attack 1 year back ,but was relieved when doctor gave him 'a pill to suck on'.Since then he is been taking only asprin and he said he refused the doctor to take any other drug.He admits to trying smoking cessation ,but he just couldn't do it .His Blood pressure is 130/85,pulse is 80/min and respiratory rate is 18/min.His physical examination is done ,heart sounds were normal.Chest auscultation revealed wheezes and crackled.Spirometry was done and found lower FEV1 to FVC ratio.His chest Xray shows enlarged anterio-posterior diameter.His ECG was done and as was as follows.ECG is showing which of the following conditions

1.Atrial Fibrialltion
2.Multifocal atrial tachycardia
3.Sick Sinus syndrome
4.Wandering pacemaker
5.AV Nodal Re-entrant Tachycardia (AVNRT)
6.Wolf Parkinson White Syndorme



I have made this Question myself,so apologies if its badly worded or has grammatical mistakes ,I just hope a good discussion of the topic ,so that we all can learn together

[koolkiller88]

Wolf Parkinson's white syndrome


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[Anders]

Originally Posted by step_enhancer

A 66 year old man comes for a routine check up ,he feels well apart from occasional cough which he tells, he is use to from a long time . He drinks alcohol 2 beers in weekends and he smokes a pack of cigarette since 30 years.He was recently vaccinated for influenza and pneumococcus.He admits of feeling fatigue at times ,but blames it to his age.He gives a history of an angina attack 1 year back ,but was relieved when doctor gave him 'a pill to suck on'.Since then he is been taking only asprin and he said he refused the doctor to take any other drug.He admits to trying smoking cessation ,but he just couldn't do it .His Blood pressure is 130/85,pulse is 80/min and respiratory rate is 18/min.His physical examination is done ,heart sounds were normal.Chest auscultation revealed wheezes and crackled.Spirometry was done and found lower FEV1 to FVC ratio.His chest Xray shows enlarged anterio-posterior diameter.His ECG was done and as was as follows.ECG is showing which of the following conditions

1.Atrial Fibrialltion
2.Multifocal atrial tachycardia
3.Sick Sinus syndrome
4.Wandering pacemaker
5.AV Nodal Re-entrant Tachycardia (AVNRT)
6.Wolf Parkinson White Syndorme



I have made this Question myself,so apologies if its badly worded or has grammatical mistakes ,I just hope a good discussion of the topic ,so that we all can learn together

6- WPW syndrom

[XpaezX]

Originally Posted by step_enhancer

A 66 year old man comes for a routine check up ,he feels well apart from occasional cough which he tells, he is use to from a long time . He drinks alcohol 2 beers in weekends and he smokes a pack of cigarette since 30 years.He was recently vaccinated for influenza and pneumococcus.He admits of feeling fatigue at times ,but blames it to his age.He gives a history of an angina attack 1 year back ,but was relieved when doctor gave him 'a pill to suck on'.Since then he is been taking only asprin and he said he refused the doctor to take any other drug.He admits to trying smoking cessation ,but he just couldn't do it .His Blood pressure is 130/85,pulse is 80/min and respiratory rate is 18/min.His physical examination is done ,heart sounds were normal.Chest auscultation revealed wheezes and crackled.Spirometry was done and found lower FEV1 to FVC ratio.His chest Xray shows enlarged anterio-posterior diameter.His ECG was done and as was as follows.ECG is showing which of the following conditions

1.Atrial Fibrialltion
2.Multifocal atrial tachycardia
3.Sick Sinus syndrome
4.Wandering pacemaker
5.AV Nodal Re-entrant Tachycardia (AVNRT)
6.Wolf Parkinson White Syndorme



I have made this Question myself,so apologies if its badly worded or has grammatical mistakes ,I just hope a good discussion of the topic ,so that we all can learn together

He has Multifocal atrial tachycardia, which is the most common arrhythmia in patients with emphysema/COPD.

If you look carefully at the P waves in the V6 long strip, or even at the others youll see 3 clearly different P wave morphologies.

[step_enhancer]

Everyone try try try !

[anomali]

multifocal atrial tachycardia....three different P wave morphologies and associated lung disease

[step_enhancer]

Originally Posted by XpaezX

He has Multifocal atrial tachycardia, which is the most common arrhythmia in patients with emphysema/COPD.

If you look carefully at the P waves in the V6 long strip, or even at the others youll see 3 clearly different P wave morphologies.

Multifocal atrial tachycardia but this patient does not have tachycardia ,his pulse is 75-80 /min

[chienpolska]

WPW syndrome

there is delta wave

[heartbeat]

No abnormal rhythm or tachycardia so exclude 1, 2, 3, and 5 and no delta wave so exclude 6
May be correct answer is Wandering pacemaker =just coz know nothing about it

[step_enhancer]

Answer. Wandering paecemaker

In cardiology, a wandering pacemaker is an atrial arrhythmia that occurs when the natural cardiac pacemaker site shifts between the sinoatrial node (SA node), the atria, and/or the atrioventricular node (AV node). This shifting of the pacemaker from the SA node to adjacent tissues is identifiable on ECG Lead II by morphological changes in the P-wave; sinus beats have smooth upright P waves, while atrial beats have flattened, notched, or diphasic P-waves.

Ventricular conduction is normal with wandering pacemaker, and thus the QRS complex is normal.

Wandering pacemaker is usually caused by varying vagal tone. With increased vagal tone the SA Node slows, allowing a pacemaker in the atria or AV Nodal area, which may briefly become slightly faster. After vagal tone decreases, the SA Node assumes its natural pace.

It is often seen in the very young, very old, in athletes and rarely causes symptoms or requires treatment

Multifocal atrial tachycardia is characterized by an electrocardiogram (ECG) strip with 3 or more P-waves of variable morphology and varying P–R intervals, plus tachycardia, which is a heart rate exceeding 100 beats per minute. Narrow QRS complexes are visible as well.

The P-waves and P–R intervals are variable due to a phenomenon called wandering atrial pacemaker (WAP). The electrical impulse is generated at a different focus within the atria of the heart each time. WAP is positive once the heart generates at least three different P-wave formations from the same ECG lead. Then, if the heart rate exceeds 100 beats per minute, the phenomenon is called multifocal atrial tachycardia.

So similarities between WAP and MAT are three different morphologies of P wave and varying PR interval
Difference is the heart rate ,if HR >100 its multifocal atrial tachycardia and if HR <100 its wandering pacemaker

[XpaezX]

WOW never heard of this disease but thanks for the question! now I learnt something good! thanks step_enhancer.. I wont forget from now on