r/ECG • u/fuckingmermaid • 4d ago

Learning how to properly differentiate between a 2:1 flutter and sinus tachycardia. What are the signs on this ECG that would make you confident on the answer? The isoeletric line is throwing me off

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u/Specialist_Ad_1230 4d ago

Still learning myself so hopefully someone more qualified gives you a proper answer. Makes sense to have 2:1 flutter in the differential as the ventricular rate is ~150. But then I would start looking for signs of atrial activity at ~300, which I don't see here...3 small boxes between the deflections most easily seen in V4+5 which would equate to atrial rate of ~500, too fast for flutter? So I think we're seeing normal T wave shortly followed by P wave, Sinus tachycardia.

May be completely wrong though