Atrial Flutter : The Great Mimic

A 70 yo patient with h/o CAD, stroke, hyperlipidemia admitted due to confusion due to sepsis.

Figure 1 - ECG case

This ECG shows:

a. Sinus tachycardia with short PR interval

b. Atrial flutter

c. Wolff-Parkinson-White Pattern

d. Junctional tachycardia

 

Figure 2 - Atrial activity marked in V1

This case has long been known to have atrial flutter and was on diltiazem, metoprolol and ribaroxaban (and of course other medications). At some point the machine would interpret this as sinus tachycardia. However, close inspection in V1 would reveal distinct atrial activity (marked) at an atrial rate of about 300 bpm. Thus, this is atrial flutter.

#441