ECG Video Blog #403 (220) — Ps,Qs,3Rs Approach to this Tachycardia ...

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 — CLICK HERE — for a Video presentation of this case! (22 minutes)

• Below are slides used in my video presentation.
• For full discussion of this case — See ECG Blog #220 —

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The long lead II rhythm strip shown in Figure-1 was obtained from an 51-year-old man who presented to the ED (Emergency Department) with "palpitations" that began 1 hour earlier.

• HOW would you interpret this tracing?
• Clinically — What would YOU do?

Figure-1: Long lead II rhythm strip, obtained from an 51-year-old man with palpitations.

Figure: The Ps, Qs, 3R Approach to Rhythm Interpretation.

 

 

Figure: I've labeled Figure-1 to illustrate estimation of heart rate (by the "every-third-beat" Method) — and — assessment of QRS duration (the solid PURPLE box showing that onset and offset of the QRS measures at least 0.12 second).

 

Figure: 12-lead ECG obtained from an 51-year-old man with palpitations.

Figure: Use of the "3 Simple Rules" for distinction between SVT vs VT (taken from ECG Blog #196).

 

Figure: Lead II rhythm strips obtained during the WCT rhythm (Panel A) — and immediately after synchronized cardioversion with 100 joules (the RED arrow shows the point where cardioversion was applied). Panel B — was obtained moments after cardioversion.

 

Figure: Following treatment with Atropine — the patient stabilized, and this 12-lead ECG was obtained.

 

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Additional Material on Today's CASE:

 

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Today’s ECG Media PEARL #37 (6:00 minutes Audio) — Reviews how to determine IF Your Patient with an Arrhythmia is Hemodynamically Stable!

 

Figure: Use of lead V1 for assessing QRS morphology during a WCT rhythm (taken from ECG Blog #196).

 

 

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Related ECG Blog Posts to Today’s Case: 

• ECG Blog #185 — Reviews my System for Rhythm Interpretation, using the Ps, Qs & 3R Approach.
• ECG Blog #210 — Reviews the Every-Other-Beat (or Every-Third-Beat) Method for estimation of fast heart rates — and discusses another case of a regular WCT rhythm.
• ECG Blog #196 — Reviews another Case with a Regular WCT Rhythm. 
• ECG Blog #197 — Reviews the concept of Idiopathic VT, of which Fascicular VT is one of the 2 most common types. 
• ECG Blog #204 — Reviews the ECG diagnosis of the Bundle Branch Blocks (RBBB/LBBB/IVCD). 
• ECG Blog #203 — Reviews ECG diagnosis of Axis and the Hemiblocks. For review of QRS morphology with the Bifascicular Blocks (RBBB/LAHB; RBBB/LPHB) — See the video ECG Media Pearl #21 in this blog post.
• ECG Blog #211 — WHY does Aberrant Conduction occur?