Monday, December 15, 2008

Interesting ECG (2)

Saw this ECG in ER.
It belongs to a lady who has underlying bronchial asthma, presented with palpitation.

Took me reaaaally some times to figure it out.
Irregular rhythm with variable PR interval, tachycardia...what do you think it is?

*The leads are well connected for the ECG so there's no cunning magic here^^

Related post:
Interesting ECG (1)


Darren Lee said...

Multifocal atrial tachycardia (MAT).

Atrial tachycardia which occurs with numerous atrial foci firing intermittently. MAT produces varying P waves on the strip and occurs most commonly in patients with chronic pulmonary disease.

Some of its characteristics:
Rhythm: Both irregular
Rate: 100 to 250 beats/min
P wave: configuration varies with at least 3 different P wave shapes
PR interval: Varies

(Feel free to correct me if you have a different opinion!;>)

Zzzyun said...

hmm seriously no idea with this one..

how abt wolf parkinson white syndrome? tot i saw some delta waves (slurred upstroke to QRS)? or is it just the P wave being too close with the QRS complex?

sigh ECG is really a complicated art to master..

ding said...

she got WPW?!?!
coz, i saw delta wave?!

eelainee said...

wow!!! ur ECG knowledge is really tip top la..

when are u free to give me crash course la wei...

Darren Lee said...

zzzyun & ding:
If you look closely, it's not really the typical "upstroke to QRS". It's more like a "notch" on the QRS, which is actually the P wave falls too close to QRS.

elaine: I'm also still learning only..=)

Zzzyun said...

ooo so that means WPW is a smooth upstroke, while this one has a notch coz the P wave too close to the QRS complex la...

but i have 1 more Q.. for atrial tachycardia, shldnt the QRS complexes be the same shape? this one seemed to have many different shapes/rates too..


Darren Lee said...

Atrial arrhythmia has got a few types: PAC, atrial tachy, atrial flutter and AF.

Under atrial tachycardia, there are a few types:
1. Atrial tachycardia (this is the one you're referring to, the rhythm is regular)

2. Atrial tachycardia with block
3. Multifocal atrial tachycardia (MAT)
4. Paroxysmal atrial tachycardia (PAT)

Cleared ur confuse?=)

Yew TW said...

manyak susah lo ini

wicrap said...

is she on theophylline or digitalis?

MAT can be caused by that too, i read somewhr before..

wicrap said...

oh, just wondering , what was ur next step in managing her ?
hehe..over-semangat asking too much.
A&E is very interesting.

- yuhhui - said...

i am totally clueless. why am I a fan of your blog.. i don't know.. lol. Makes me feel dumb whenever i read all your medical stuff. I was just wondering.. when only can i achieve your level of knowledge. Haha.

Zzzyun said...

oh ok.. i didnt know there were so many types of atrial tachycardia!!

coz i was reading 'ECG Made Easy', and it mentioned that for atrial tachycardia, the QRS complexes are regular because the depolarization of the ventricles are normal..

looks like i hv more to learn. do u have any ECG books to recommend?

btw thanks for teaching us this!! ^^

Anonymous said...

not atrial flutter?

Darren Lee said...

wicrap: Management ah..very long lecture ler..hehe. Maybe next time i summarize it into formulas and post it..ya A&E is indeed interesting!;)

yuhhui: HEY what la you're just at the very beginning of the journey lerr..when you becomes a MO i'm sure you'll be just as good, if not better!=)

zzzyun: Sigh before this i was also using "ECG made easy" and thought it should be enough. But certainly it's not. I mean if you're interested in medical, you should definitely get other books for further learning.

Anonymous: Hi pls leave your name!^^
In Atrial flutter,
the atrial rhythm is regular where as the ventricular rhythm is not. You'll see the classical "flutter waves aka sawtooth pattern", as a result of atrial beats > vent beats with blocks (e.g. 2:1 to 4:1).
And in atrial flutter, the PR interval is unmeasurable and QT interval is unidentifiable.

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