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Example 25

1,566 bytes added, 13:37, 5 November 2008
New page: thumb| The ECG * Following the 7+2 steps: **Rhythm ***'''The ECG shows a regular fast rhythm. P waves are not easily discernible but might well be located just afte...
[[Image:DVA0229.jpg|thumb| The ECG]]


* Following the 7+2 steps:
**Rhythm
***'''The ECG shows a regular fast rhythm. P waves are not easily discernible but might well be located just after each QRS complex (for example in lead II)'''
**Heart rate
***'''almost 300bpm'''
**Conduction (PQ,QRS,QT)
***'''The PQ and QT interval is hard to define, QRS complexes are small'''
**Heartaxis
***'''QRS positive in I and AVF: normal heart axis'''
**P wave morphology
***'''Negative P-waves in inferior leads'''
**QRS morphology
***'''Normal QRS complexes, normal axis, normal R-wave progression in precordial leads (V1 to V6)'''
**ST morphology
***'''Because of the fast rhythm the ST segments and T waves are not easy to interpret, there seems to be ST depression with negative T waves in the inferior and lateral leads .'''
**Compare with the old ECG (not available, so skip this step)
**Conclusion?


'''A regular small-QRS tachycardia at about 300bpm with normal looking QRS complexes is most likely an [[Atrial flutter]] with 1:1 conduction over the AV node. Carotid sinus massage or adenosine would slow down AV conduction and would uncover the typical 'saw-tooth' P-waves at 300bpm.

It might be that such a fast ventricular rhythm causes myocardial ischaemia without coronary artery disease. Most likely this is a young individual, older individuals often do not have AV node-conduction abilities at these high rates and they would show for example 1:2 or 1:3 AV-block whith the atrial frequency still at 300bpm but with the ventricles activated at 150 or 100bpm.'''

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