The ECG at 22:36 is not just AF.. It's AF with WPW (or some other accessory pathway).. ECG features 1) Irregularly irregular rhythm with rate >200 2) QRS with varying width & morphologies AF with fast ventricular rate can't go beyond a rate of around 200, bcz of the decremental conduction property of the AV node. So if the rate of AF goes beyond 200, there must be an accessory pathway connecting the atria to the ventricles (such as WPW) Clinical significance of AF with WPW: Av nodal blockers like Adenosine, BB, CCB, Digoxin & Amiodarone is contraindicated. Bcz if you administer any of these drugs, it would block the AV node & all the 350-600 atrial impulses formed in AF would travel down the accessory pathway, thereby converting AF to VF ..
That was a 10 second strip. For irregularly irregular rhythm, you determine the rate by multiplying the number of R waves on the rhythm strip by 6. 6 times 23 = 138. the QRS are narrow, definitely below 120ms. There are diffuse ST depressions (both downsloping and horizontal) some of which are above 1mm. This indicates A-fib with diffuse ischemia which suggests an unstable A-fib. The patient needs electrical synchronized cardioversion.
When you see a regular heart rate at about 150/min you should suspect Atrial flutter (with 2:1 block). The flutter waves can have a more rounded shape but are nonetheless about 300/min (aproximately one flutter wave per big box). I don't remember whether I ever saw that in my own practice, but I saw that on Medscape's "ECG of the week" section. Go there and enjoy some interesting ECG ;)
@@drdannegoita Thanks! I'm a monitor tech but we do a basic interpretation only. I saw a lot of heart rhythms and hard to interpret. I wish I could email you the paper.
