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Morning report ECG. Elias B Hanna, MD LSU New Orleans, Cardiology. What is the diagnosis?. QRS width. Narrow complex tachycardia QRS<120 ms =SVT. QRS width. Narrow complex tachycardia QRS<120 ms =SVT. Irregularly irregular. 1.Afib 2.MAT (P waves of

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Morning report ecg

Morning report ECG

Elias B Hanna, MD

LSU New Orleans, Cardiology



Morning report ecg

QRS width

Narrow complex

tachycardia

QRS<120 ms

=SVT


Morning report ecg

QRS width

Narrow complex

tachycardia

QRS<120 ms

=SVT

Irregularly

irregular

1.Afib

2.MAT

(P waves of

≥3 different

morphologies)


Morning report ecg

QRS width

Narrow complex

tachycardia

QRS<120 ms

=SVT

Irregularly

irregular

Regular or regularly irregular

1.Afib

2.MAT

(P waves of

≥3 different

morphologies)


Morning report ecg

QRS width

Narrow complex

tachycardia

QRS<120 ms

=SVT

Irregularly

irregular

Regular or regularly irregular

Beside sinus tachy

1.AVNRT

2.AVRT

3.Atrial tachycardia

4.Atrial flutter

1.Afib

2.MAT

(P waves of

≥3 different

morphologies)


Morning report ecg

Dual AV node pathways and AVNRT

Some individuals have dual AV node pathways (up to 20% of individuals). Normally, conduction spreads through the fast pathway and gets blocked in the slow pathway. However, after a PAC, the electrical activity cannot spread through the fast pathway (which is still in a refractory period), but can get conducted through the slow pathway which then conducts both down to the ventricle and up to the atrium, through the recovered “fast pathway”, thus creating a tachycardia with retrograde P waves


Morning report ecg

AV node

AV node

Accessory

pathway

AVRT (after PAC or PVC)

AV node

Accessory

pathway

Similar process happens in case of accessory pathway that is conducting retrogradely. We have 2 pathways that create a reentrant circuit after a PAC or PVC.


Morning report ecg

Arrows point to the retrograde P that is superimposed on ST segment and looks as a notch on ST segment

Retrograde P wave

Pseudo-r’ in V1 + Pseudo S in inf leads


Morning report ecg

ECG of the previous pt in sinus rhythm after adenosine. Note the difference (no “pseudo-r’ “ or “pseudo S”)


Morning report ecg

QRS width the difference (no “pseudo-r’ “ or “pseudo S”)

Narrow complex

tachycardia

QRS<120 ms

=SVT

Irregularly

irregular

Regular or regularly irregular

Look for P waves

1.Afib

2.MAT

(P waves of

≥3 different

morphologies)

Assess RP interval

Sawtooth P,

esp. rate~150

-Atrial flutter

Short RP (<1/2 RR)

-AVNRT

-AVRT

-Atrial tachycardia

Long RP (>1/2 RR)

-Atrial tachycardia

-Atypical AVNRT