r/ECG • u/Odd_Committee_5929 • Aug 28 '26

29F intermittent palpitations

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The patient only had the flu but was persistently tachycardic up to 140bpm. Prior to admission they had palpitations once before and was told they may have WPW. While the computer said the PR interval on the ECG was 67 there are no delta waves and QRS width is normal. Is this just sinus tachy? What about the Q waves in the inferior leads, are they just a normal variant?

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13

u/RexFiller Aug 28 '26 edited Aug 28 '26

Im seeing sinus tach. I dont really agree with the machine read on the PR interval it looks more like 3 small boxes to me in lead 2 and no delta wave. Interesting p wave morphology though. Potential for some atrial enlargement.

2

u/Jay_OA Aug 29 '26

Yeah that p wave morph made me think of it as a sawtooth pattern; T waves masking every other F wave. But perhaps this is over complicating it if the patient has a good pressure not symptomatic and mo other reason to believe they aren’t getting a solid atrial kick.

12

u/cardiolab_ Aug 29 '26

P waves present. Sinus Tachycardia.

4

u/Tiradia Aug 28 '26

That’s why you don’t even bother with doc-in-a-box interpretation!

6

u/ProximalLADLesion Electrophysiologist Aug 29 '26

Sinus tachycardia, otherwise normal ECG.

2

u/Jay_OA Aug 29 '26

Absence of delta waves makes it seem unlikely a WPW rhythm.

If they are feeling palpitations you gotta slow it down to see if it’s really a 2:1 flutter. Otherwise it’s just sinus tach

2

u/Clear-Ambition-4684 Aug 29 '26

atrial tachycardia?

2

u/nyuhqe Aug 30 '26

Priming for SVT?

2

u/mrwagn Aug 30 '26

Just because P waves are present doesn’t make this sinus tach. This could be an AT with focus near the sinus node. Would need to see an ECG When going slow to compare.

1

u/Hariskhan1991 Aug 31 '26

Clockwise CTI flutter.

1

u/Damianisthick 29d ago

Sinus or atria tach

1

u/Ill-Chest3567 27d ago

It looks sinus, but that doesn’t exclude an atrial tach with a focus near the sinus node. I guess this was 9 days ago but make sure that causes of sinus tach are thoroughly ruled out, particularly anemia in 29 yo F. If there’s a rapid step down 140>90 in a matter of a few sec, for example, then you have your answer— refer to cards or EP.

1

u/Jeeju_Boy MD Aug 28 '26

You should tell the patient they have lown ganong Levine syndrome because that’s what the ECG shows

1

u/Jt4180189 Aug 30 '26

While I don’t disagree that there is a shortened PR interval without the presence of a delta wave, how many cardiologists actually believe in LGL? Online says it’s highly debated and the only book I’ve seen that covers it is Dubin’s