McGill Case 263

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 262 | Next Case: McGill Case 264

This is a recording from a patient being treated for a wide complex tachycardia . The recording could be sinus with a first degree block (plus a partial right bundle branch block or possibly RVH). It is to be noted though that a sinus rate of 100/min seems some what fast for a patient on nadolol and that the rhythm is irregular. On the other hand, the more likely rhyhtm is SVT (or slow atrial flutter at a rate of 200/min) with variable block though mostly 2:1 block. This is an atrial rate similar to that of the wide complex tachycardia, and if one looks in lead I and lead V1 there does appear to be atrial activity at twice the ventricular rate.