65 y female with history of heart failure presented with palpitation

The correct answer is “Atrioventricular nodal reentry tachycardia (AVNRT)”

In the beginning, there are sinus beats that are conducted with 1st degree AV block. These beats are followed by ectopic atrial contractions which are not conducted through AV node (blocked PACs). However, an ectopic atrial contraction eventually triggers an AVNRT, a regular narrow complex tachycardia with relatively long RP intervals due to slow conduction through retrograde pathway in the AV node.

Special Thanks to my dear friend salvatore salvatore for providing the diagram.

#case199 ❤️

55 y female with history hypothyroidism presented with palpitation and lightheadedness.

The correct answer is “Atrial flutter”

ECG features:
• Narrow complex tachycardia at ~160 bpm.
• Sawtooth flutter waves are seen best in the inferior leads (II, III, and aVF)
• There is a clear 2:1 relationship between the flutter waves (~320 bpm) and QRS complexes (~160 bpm).

#case200 ❤️

75 year old man with 2 hours chest pain.

The correct answer is “Left anterior descending artery (LAD)”

The ECG shows upslope ST-Depressions and peaked T waves in the anterior leads. this pattern is called “De Winter T wave” and seen in ~2% of acute LAD occlusions.

#case201 ❤️

55 year old man, known case of CKD presented with sudden onset chest pain and palpitation.