A 64-year-old male came with a history of acute onset palpitation along with dyspnoea, orthopnea, and paroxysmal nocturnal dyspnoea. The patient was a known case of severe aortic valve stenosis with aortic valve regurgitation with moderate mitral regurgitation and was on medical follow up. ECG of the patient during tachycardia is shown below.
ECG is showing heart rate of 156 beats per minutes, narrow QRS complex, irregularly irregular, P wave is seen, RP interval is long then PR interval, there is ST segment depression in lead V4-V6, so the ECG is suggestive of narrow QRS complex irregularly irregular, long RP tachycardia with visible P wave, so the most likely differential diagnosis atrial tachycardia or atrial flutter with 1:1 AV conduction.
Another ECG Of the patient taken five minutes after first ECG
ECG is showing heart rate of 98 beats per minutes, irregularly irregular, there are P wave present which is of Sawtooth appearance, P wave is positive in lead 2,3,avF, there is ST segment depression seen in lead I,II, III, V5,V6 so the ECG is suggestive of atrial flutter with variable block.
Lets discuss how to approach in a patient with narrow QRS complex tachycardia
Thank you
Praveen Gupta
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