EKG of the Week
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This patient was sent to the emergency room after being noted in clinic to be tachycardic.
+ EKG Interpretation
Dr. Ohlbaum's Explanation
The computer called it sinus tachycardia, what do you think?
It is a regular rhythm but the rate is fast (~125) and it is a little wide. Are there P waves? Well at first glance it looks like there might be P waves in Vl, but look more carefully and you will see that in Vl there are 2 "ups" one between the QRS and the T and another between the T and the next QRS. They march through perfectly regularly in a 2:1 pattern compared to the QRS. You can also march through a downward deflection in the inferior leads at the same pace. So, this is atrial flutter with 2:1 block. It is common in atrial flutter with 2:1 for one part of the flutter to end up on top of the QRS in at least some leads making it hard to see in those leads. The computer frequently calls that sinus, but it is not correct.
What about the wide QRS?
This is a typical left bundle branch block with a wide QRS, a broad slurred QRS in the lateral leads and ST and T waves opposite the QRS. The patient is known to have a left bundle branch block.
