McGill Case 66: Difference between revisions

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[[File:E0007661.jpg|thumb|600px|left|The first tracing was recorded in the emergency room, and is from a 70 year old woman with two sycopal attacks. She was on metoprolol and diltiazem for angina {normal coronaries and an abnormal MIBI perfusion scan}.]]
[[File:E0007661.jpg|thumb|600px|left|This is an interesting set of tracings, as it shows the effect of adenosine on AV conduction, but in addition the effect on atrial refractoriness.
The first tracing is clearly atrial flutter with an atrial rate of 270/min, and a ventricular rate of 135/min. The second recording shows much faster atrial activity (Note the distance between the turquoise arrows and the yellow arrows which mark out 3 atrial cycles). The second tracing is either atrial fibrillation (a know result of adenosine) or a faster atrial flutter (type II flutter) with variable block. Both of these effects could be seen as a result of the decrease in the atrial refractory period by the stimulation of the adenosine.]]


[[File:E0007662.jpg|thumb|600px|left|This tracing was taken in the intensive care unit after a temporary pacing wire (soft semi-floater) was placed via the right internal jugular vein. The lead paced the ventricle well, but the patient immediately complained of moderate chest pain, better with sitting up.]]
[[File:E0007662.jpg|thumb|600px|left|]]

Latest revision as of 01:07, 15 February 2012

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This case report is kindly provided by Michael Rosengarten from McGill and is part of the McGill Cases. These cases come from the McGill EKG World Encyclopedia.


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This is an interesting set of tracings, as it shows the effect of adenosine on AV conduction, but in addition the effect on atrial refractoriness. The first tracing is clearly atrial flutter with an atrial rate of 270/min, and a ventricular rate of 135/min. The second recording shows much faster atrial activity (Note the distance between the turquoise arrows and the yellow arrows which mark out 3 atrial cycles). The second tracing is either atrial fibrillation (a know result of adenosine) or a faster atrial flutter (type II flutter) with variable block. Both of these effects could be seen as a result of the decrease in the atrial refractory period by the stimulation of the adenosine.
E0007662.jpg
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