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- W2916867492 abstract "HomeCirculationVol. 133, No. 2ECG Response: January 12, 2016 Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBECG Response: January 12, 2016 Originally published12 Jan 2016https://doi.org/10.1161/CIRCULATIONAHA.115.020740Circulation. 2016;133:232–233ECG Challenge: A 70-year-old man with a history of chronic obstructive pulmonary disease treated with inhalers presents to his pulmonologist with increasing shortness of breath that he thinks may be related to chronic obstructive pulmonary disease. He has noted intermittent palpitations. His physician checks his blood pressure, which is 100/70 mm Hg, and also notes a rapid heart rate prompting an ECG.Download figureDownload PowerPointThere is a regular rhythm at a rate of 150 bpm; however, there are 2 long RR intervals (↔). The QRS complex is narrow (0.08 s), and it has a normal morphology and normal axis between 0° and 90° (positive QRS complex in leads I and aVF). The QT/QTc intervals are slightly prolonged (300/470 ms). There is nonspecific T-wave flattening. There is evidence of atrial activity (+) best seen in leads V1 and V3, although atrial waveforms can be seen in other leads (v). The RP interval (0.28 s) is longer than the PR interval (0.18 s). Hence, this is a long RP tachycardia. There are several causes for a long RP tachycardia, including the following:Sinus tachycardiaAtrial tachycardiaAtypical atrioventricular nodal reentrant tachycardia, ie, fast-slowEctopic junctional tachycardiaAtrioventricular reentrant tachycardiaAtrial flutter with 2:1 blockImportantly, during the 2 long RR intervals, there is evidence of atrial activity (*) and the PP interval is constant (└┘) with a rate of 300 bpm. The only regular atrial rhythm at a rate >260 bpm is atrial flutter. Therefore, the underlying rhythm is atrial flutter with primarily 2:1 atrioventricular conduction. The long RR intervals are the result of a higher degree of atrioventricular block (ie, 3:1 and 4:1).Please go to the journal’s blog, OpenHeart, for more ECG Challenges: http://goo.gl/tQPNFp. Challenges are posted on Tuesdays and Responses on Wednesdays.FootnotesCorrespondence to Philip J. Podrid, MD, West Roxbury VA Hospital, Section of Cardiology, 1400 VFW Pkwy, West Roxbury, MA 02132. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetails January 12, 2016Vol 133, Issue 2 Advertisement Article InformationMetrics © 2016 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.115.020740PMID: 27028436 Originally publishedJanuary 12, 2016 PDF download Advertisement" @default.
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- W2916867492 title "ECG Response: January 12, 2016" @default.
- W2916867492 doi "https://doi.org/10.1161/circulationaha.115.020740" @default.
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