Atrial Flutter (mis)interpreted as Sinus Rhythm

A 70 pt h/o HTN, dyslipidemia, cardiac arrhythmia, CHF, PVD, DM

c/o L leg pain. What is the rhythm?

a. Sinus Rhythm

b. Atrial Flutter

c. Atrial fibrillation

d. Accelerated Idioventricular Rhythm

Figure 1

Figure 2 - ECG case atrial activity marked

This regular wide QRS rhythm which was interpreted by the machine as sinus rhythm and sometimes atrial fibrillation. Close inspection reveals distinct organized atrial activities (best seen in V1 and V2) at a rate of about 300 bpm. Thus, this is atrial flutter, left bundle branch block, left anterior fascicular block, low voltage limb lead with poor R wave progression.

The work-up negative for venous/arterial thrombosis. The leg pain was attributed to musculoskeletal injury. 

*This is a nice case for atrial flutter mistaken for atrial fibrillation and sinus rhythm.

#421