Question
A 40 year old lady comes to the emergency department from her husband’s funeral with a sensation of ‘fluttering’ in her chest. She is feeling very anxious. An ECG is performed. What is the diagnosis?
A. Atrial Fibrillation.
B. Atrial Flutter.
C. Supraventricular Tachycardia.
D. Normal Rhythm.
Show Answer
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Correct Answer » C
Explanation
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Ans: C. Supraventricular Tachycardia.
ECG in the image shows:
| Rate |
160 |
| Rhythm |
Regular |
| Axis |
Normal |
| PR/P wave |
Not visible |
| QRS |
Narrow |
| ST/T wave |
Slight lateral ST depression |
| QTc/other |
Normal |
Diagnosis:
- The history makes a sinus tachycardia secondary to anxiety seem likely.
- However, sinus rhythm rarely goes above 120 BPM and in this case there are no p-waves visible.
- This is therefore a junctional supraventricular tachycardia (SVT): a narrow-complex tachycardia originating from the AV node.
- Treatment includes vagal manoeuvres followed by adenosine.
- Atrial flutter would be a reasonable differential as the rate is regular and close to 150.
- However, there is no variation in the baseline and not a hint of sawtooth appearance so this is less likely than SVT.
