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| Multiple lead rhythm strip obtained after adenosine administration. Note distinctive p waves (circled). Click pic to enlarge. |
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Answer to "What is this patient's cardiac rhythm?"
According to the poll results, most MEMB readers thought that the cardiac rhythm was atrial flutter and this would be an excellent guess. However, the rhythm strip which was obtained after administration of adenosine doesn't demonstrate the classic saw-tooth pattern of flutter waves but rather quite distinctive p waves (circled on EKG below). These p waves can't be from the sinus node though because there's little variation in the heart rate over time - sticking consistently around 150 - and the PR interval is quite short (suggesting an ectopic focus close to the AV node). Final diagnosis, as confirmed by EP study, was ectopic atrial tachycardia. Patient was treated with EP ablation and did well.