A 43 year old male came to JIPMER hospital, Pondicherry, India with chief complaints of palpitation on and off since last 2 years which were acute in onset, not associated with any exertion, vomiting, nausea, vomiting, giddiness, chest pain or syncope. Tachycardia subsided on its own after one or two hours. There was no history of diabetes mellitus, hypertension, hyperthyroidism, coronary artery diseases. Last episode of palpitation occur 25 days back, ECG done at private hospital following which patient was referred to JIPMER Cardiology department for electrophysiological study and further managment. During evaluation in the OPD patient pulse was 94 beats per minute, BP 146/90 mmhg, cardiovascular and respiratory system were unremarkable. ECG of the patient is shown below.
ECG during tachycardia
Continued.................
Description of the ECG-Narrow QRS complex tachycardia with heart rate 250 beats per minute, normal axis, Negative P wave seen in lead II,III,avF, Pseudo R wave seen in lead V1, RP interval nearly 50 msec, PR interval 200 msec, no ST-T wave changes, no QRS alternans seen so the ecg is suggestive of Narrow complex regular short RP tachycardia most likely etiology being AVNRT.
ECG during sinus rhythm
Normal sinus rhythm at 75 beats per minute, normal axis, no ST-T wave changes seen.
So the diagnosis is PSVT most likely AVNRT. Lets see how to approach in a patient with narrow complex regular short RP tachycardia.
Thank you.
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