Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

In the ECG Quest archives, this ECG has been tagged with: - Chest pain Dyspnoea Absent P waves Anterior ST depression Extreme tachycardia Inferior ST elevation Narrow QRS Normal Axis Reciprocal ST depression Regular Tachycardia Atrial flutter Multi-vessel disease 12-Lead Dr Smith's ECG Blog CC BY-NC

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This ECG is from a man in his 60s who presented with intermittent shortness of breath and chest pressure over the past few days. This was his initial ECG.

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ECG Archives:
Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

This ECG shows a regular narrow complex tachycardia around 200 bpm, without P waves, with marked ST elevation in inferior leads and ST depression in anterior leads and aVL. The cause was thought to be atrial flutter from newly started flecainide. He also underwent angiography and had stents inserted to the left circumflex and right coronary arteries.

Tags:

Chest pain Dyspnoea Absent P waves Anterior ST depression Extreme tachycardia Inferior ST elevation Narrow QRS Normal Axis Reciprocal ST depression Regular Tachycardia Atrial flutter Multi-vessel disease 12-Lead Dr Smith's ECG Blog CC BY-NC

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Rate
Regularity
QRS width
Absent P waves
Anterior ST depression
Anterior ST elevation
Asymmetrical P in V1
Biphasic T waves
Bradycardia
Cabrera's sign
Capture beat
Changing Axis
Changing PR interval
Chapman's sign
Concordant ST depression in V1-V3
Concordant ST elevation
Coved ST elevation
Dagger Q waves
De Winter T waves
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Delta wave
Discordant ST changes
Downsloping ST depression
Early R wave transition
Electrical alternans
Epsilon wave
Excessive discordant ST depression.
Excessive discordant ST elevation
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Extreme tachycardia
Fibrillation waves
Flat ST segment
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Fragmented QRS
Fusion beat
Grouped
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Indeterminate axis
Inferior ST depression
Inferior ST elevation
Intermittent LBBB
Inverted P waves
Inverted T waves
Inverted U waves
Irregular
J wave
Late R wave transition
Lateral ST depression
Lateral ST elevation
Lead I sign
Left Axis Deviation
Long PR
Long QT
Narrow QRS
Normal Axis
Normal P waves
Normal PR
Normal Q wave
Normal QT
Normal R wave transition
Normal rate
Normal ST segment
Normal T waves
Normal U waves
Osborn wave
P wave
Pacemaker spikes
Pathological Q waves
Peaked T waves
PR interval & segment
PR segment depression
Prolonged R wave peak time
Pseudo-normalised T waves
Pseudo R' wave
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Q waves
QRS axis
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QRS shapes
R in aVR
R in V1
Reciprocal ST depression
Regular
Retrograde P waves
Right Axis Deviation
RSR'
S1Q3T3
Saddleback ST elevation
Septal ST elevation
Shark fin ST elevation
Short PR
Short QRS
Short QT
Sine wave
Spiked helmet sign
Horizontal ST depression
ST elevation in a PVC
ST elevation in aVL
ST elevation in aVR
ST elevation in III>II
ST elevation in posterior leads V7-9
ST elevation in V1
ST elevation in V4R
ST segment
Straightened ST segment
T-U waves
T and U waves
Ta wave
Tachycardia
Tall P waves
Tall QRS
Tall U waves
Terminal QRS distortion
Tombstone ST elevation
Upsloping ST depression
Variable P waves
Ventricular tachycardia - monomorphic
Vertical axis
QT interval
Wellens Waves
Wide P waves
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Widespread ST depression
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Other waves
Sinus Rhythms
Atrial Rhythms
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Other Rhythms
Accelerated idioventricular rhythm
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Atrial escape beat
Atrial fibrillation
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Atrial pacemaker
Atrial tachycardia
Atrial tachycardia - multifocal
AVNRT
AVNRT fast-slow
AVRT antidromic
AVRT orthodromic
Bigeminy
Blocked premature atrial complex
Change in rhythm
Coronary sinus rhythm
Failure to capture
ICD Overdrive Pacing
Isorhythmic dissociation
Junctional escape
Junctional tachycardia
Multiple rhythms
Non-sustained VT
Normal Sinus Rhythm
Pacemaker failure
Pacemaker mediated tachycardia
Parasystole
Premature atrial complex
Premature junctional complex
Premature ventricular complex
Pulseless Electrical Activity
Right Ventricular Outflow Tract Tachycardia
Sinus arrest
Sinus arrhythmia
Sinus bradycardia
Sinus node re-entrant tachycardia
Sinus pause
Sinus tachycardia
SVT
Torsades de Pointes
Trigeminy
Ventricular escape
Ventricular escape beat
Ventricular Fibrillation
Ventricular flutter
Ventricular pacemaker
Ventricular standstill
Ventricular tachycardia
Ventricular tachycardia - bidirectional
Ventricular tachycardia - fascicular
Ventricular tachycardia - polymorphic
Wandering atrial pacemaker
Wide complex tachycardia
SA Blocks
AV Blocks
BBB/Hemiblocks
Multiple Blocks
Ashman aberrancy
Bifascicular block
First degree AV block
High grade AV block
Incomplete LBBB
Incomplete RBBB
Intraventricular conduction delay
LAFB
LBBB
LPFB
RBBB
Second degree AV block
Second degree AV block 2:1
Second degree AV block Mobitz type 2
Second degree AV block type 1 - Wenckebach
Third degree AV block
Trifascicular block
Type I SA block
Type II SA block
Ventriculophasic sinus arrhythmia
Acute right heart strain
Aortic dissection
Aortic stenosis
Arrhythmogenic Right Ventricular Cardiomyopathy
Atrial Septal Defect
Beta blocker toxicity
Brugada syndrome
Brugada syndrome type 1
Brugada syndrome type 3
Calcium channel blocker toxicity
Carbamazepine toxicity
Cardiac T-wave memory
COPD
Cor pulmonale
Coronary artery spasm
CVA
Dextrocardia
Digoxin effect
Digoxin toxicity
Dilated cardiomyopathy
Electrolytes
Familial catecholaminergic polymorphic ventricular tachycardia
Hypertrophic cardiomyopathy
Hypercalcaemia
Hyperkalemia
Hyperthermia
Hyperthyroidism
Hypertrophy and enlargement
Hypocalcaemia
Hypokalemia
Hypomagnesaemia
Hypothermia
Hypothyroidism
Juvenile T wave pattern
Lead misplacement
Left atrial enlargement
Long QT syndrome
Lown Ganong Levine syndrome
LV aneurysm
LVH
Metabolic acidosis
MINOCA
Myocardial Bridging
Myocardial rupture
Myocarditis
Normal
Normal ST elevation
Pericardial effusion
Pericarditis
Propranolol toxicity
Pulmonary embolism
Pulmonary and Pericardial
Quetiapine toxicity
Raised intracranial pressure
Restrictive cardiomyopathy
Reverse Takotsubo
Right atrial enlargement
RVH
Short QT syndrome
Sick sinus syndrome
Sodium channel blocker toxicity
Sotalol toxicity
Spontaneous coronary artery dissection
STEMI Mimics
Syndromes
Takotsubo cardiomyopathy
Toxicology / Overdose
Wellens syndrome
Wolff Parkinson White syndrome
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Abdominal pain
Blunt Trauma
Cardiac arrest
Cardiovascular symptoms
Chest pain
Chronic kidney disease
Cough
Diarrhoea
Dizziness
Dyspnoea
Fever
General symptoms
Hypertension
Hypotension
Fatigue
Long lie
Loss of consciousness
Muscle pains
Paediatrics
Palpitations
Screening
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Other Problems
Syncope
Vomiting
Weakness
Introduction
12-Lead
Recording a 12-Lead ECG
Waves
Standard Calibration
Nonspecific baseline artefact
Quality Issues and Artefact
Chest compression artefact
Chest leads
Electrical interference artefact
Electrode Detachment
Electrode misplacement
Fistula artifact
High V1/V2 misplacement
Incorrect Machine Interpretation
Ladder diagram
LA/LL electrode reversal
LA/LL + RA/RL electrode reversals
LA/RA electrode reversal
LA/RL electrode reversal
Lewis lead
Limb leads
Movement artefact
Paediatric
Posterior leads
RA/LL electrode reversal
RA/RL electrode reversal
Rhythm Strip
Right leads
Serial 12-lead
Transcutaneous pacing artefact
Wandering baseline
Double speed 50 mm/sec

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