McGill Case 338

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. Previous Case: McGill Case 337 | Next Case: McGill Case 339

This is an electrocardiogram from an 82 year old man with a history of lung disease and renal failure. At the time of this recording the patient was on Iron, Lasix, and bronchodilators. The EKG shows a regular rhythm at a rate of 141/min. This patient had been in atrial fibrillation in the past and the rhythm here is probably atrial flutter with 2:1 block although no flutter waves are seen. The QRS duration is widened at 105 ms and the tall R waves in V5 and S waves in V1 and V2 and the ST depression in the absence of digoxin suggest left ventricular hypertrophy. The QRS is too narrow for ventricular tachycardia and the brief R wave in V2 with the clean down-stroke of the V2 S wave argue against a ventricular origin. The patient was placed on digoxin with a slowing of the ventricular rate and a rhythm that was clearly atrial fibrillation and with a QRS with the same morphology.