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Discussion in 'Spot Diagnosis' started by Egyptian Doctor, Jan 17, 2013.

  1. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

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    What is your medical diagnosis ?

    ECG.jpg
     

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  2. Emergency medicine Mike

    Emergency medicine Mike Bronze Member

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    PSVT. (Paroxysmal supraventricular tachycardia.)
     

  3. neo_star

    neo_star Moderator

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    totally agree with Extremely Magnificent Mike ! it's PSVT

    point in favor - Narrow complex tachycardia ( which rules out ventricular origin ) ...so it is AV nodal or higher up. Most likely PSVT and here again reentry more likely than automaticity. Patient hx will give clue...if he says heart rate increased gradually..then more likely increased automaticity. but if he says that it happened in a flash..then more likely - reentrant.
     

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  4. dilsh123

    dilsh123 Young Member

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  5. yptan

    yptan Active member

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    Why not atrial fibrilation?
     

  6. Emergency medicine Mike

    Emergency medicine Mike Bronze Member

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    Because rhytm is strictly regular. Its supraventricular reentry mechanism.
     

  7. u4534590

    u4534590 Active member

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    Narrow complex tachy -> SVT (like neo said)
    Pretty impressive rate! Maybe av nodal retry but hard to tell :)
     

  8. kangourou

    kangourou Famous Member

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    I agree, this is an SVT and most likely AV node re-entry as neo-star explained.

    Yptan: The rhythm strip shows a tachycardia with regular R-R intervals i.e. it is a regularly regular rhythm. Other than that we can see a narrow QRS complex and prominent t-waves. I presume your question of whether or not this is AF comes from the fact there are no discernible p-waves. It is true that in fast AF you could see a tachycardia with absent p-waves, but the difference is that the rhythm would be irregularly irregular as impulses reaching the ventricles from the atria would be at random.

    [​IMG]
    This image shows atrial fibrillation with a fast ventricular response, and although it's not as easy to spot with such a fast rate, the r-r intervals are irregular, giving us an irregularly irregular rhythm.

    [​IMG]

    In this case the p-waves are not seen as they occuring simultaneously with the QRS complex and as such are hidden. This would very much suggest re-entry within the AV node.

    I hope that helps
     

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  9. dr.angela

    dr.angela Bronze Member

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    Paroxysmal supraventricular tachycardia
     

  10. yptan

    yptan Active member

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    Thank you so much Kangourou and Mike. I understand.
     

  11. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

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    Answer : Paroxysmal supraventricular tachycardia

     

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