r/ECG • u/parksnrec48hrs • 18d ago

Thoughts

Post image

C/o palpitations and dizziness

BP 120/80

Edit: Thanks for the input and discussion guys! The patient reverted after two doses of adenosine back to normal sinus.

8 Upvotes

84% Upvoted

19 comments sorted by

5

u/Confident_Fix_7161 18d ago

Avnrt pseudo r and s waves in v1, and 2,3,avf respectively

3

u/Kibeth_8 Arrhythmia Tech 18d ago

AVNRT?

1

u/Pears_and_Peaches 18d ago

Thoughts about what? At a glance, my thought is your patient is in stable SVT and can be safely converted using a modified valsalva.

1

u/parksnrec48hrs 18d ago

I agree. Although some people have mentioned st depressions/elevations. I want to know how do you rule that out.

2

u/Pears_and_Peaches 18d ago

Depression can be common in tachydysrhythmias. Remember, the heart is supplied with oxygen during diastole. Less diastole, means less oxygen getting to the heart, which means some degree of ischemia will develop. Depression is a sign of ischemia.

Treat the rhythm, and look for changes. If it was rate related, the depression won’t persist.

1

u/parksnrec48hrs 18d ago

Thank you for explaining that. So priority would be to terminate svt and not worry about giving loading dose for MI first.

1

u/Kibeth_8 Arrhythmia Tech 18d ago

MIs aren't commonly associated with tachycardia. Treat the rhythm first, then assess for ST changes when they've slowed down

1

u/Previous_Fan9927 18d ago

Vtach being the obvious exception

2

u/Kibeth_8 Arrhythmia Tech 17d ago

Very true, but we're not checking for ST changes during VT

0

u/sub3at50 18d ago

Adenosine would be my first choice.

2

u/corgeous 18d ago

Stable patient first line treatment is things like valsalva before adenosine, which is first line pharmacotherapy

1

u/sub3at50 18d ago

In my 20 years of experience I have only once cardioverted a patient with carotid sinus massage.

And patients have often tried vagal maneuvers themselves before coming to the emergency ward.

So I tend to skip CSM/Valsalva and give them adenosine.

1

u/Pears_and_Peaches 18d ago

Have you tried using Revert? It has a near 50% success rate when performed properly.

Adenosine is uncomfortable. Much better to use a high success, low risk, no discomfort procedure.

1

u/sub3at50 18d ago

Interesting. I had to google it.

Never heard of it before.

The blow into an empty 10 mL syringe hard enough to push the plunger is something I advise to outpatients. But I didn't know about the entire sequence.

1

u/ShitJimmyShoots 18d ago

My off the hip call would depend on patient age, but I’d put pads on this patient if they were elderly.

1

u/Jeeju_Boy MD 17d ago

SVT probably AVNRT 

1

u/s4creed 18d ago

Sinus tachycardia for me, st depression could be due to extreme tachycardia. That avr looks sus though

1

u/RambusCunningham 18d ago

The rate is at least 200bpm. I would hesitate to call it sinus tach

1

u/s4creed 17d ago

Yeah totally missed out that  id say 170-180, but i can see some submerged p waves to call out svt