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Monday, 13 August 2012


ECG Class case 5

Remember to follow the methodical analysis plan from the earlier blog.

Firstly – Can you see P- waves?
No. Not clearly.

What is the rate?
Atrial Rate – not possible to calculate in the absence of P waves. Ventricular rate – 110 - 120bpm
Remember the ‘ready-reckoner’ from case study 4? How to calculate rate quickly?

For regular rhythms: Rate = 300 divided the number of large squares between 2 complexes.
For irregular rhythms: Rate = The number of complexes in 30 large squares (ie 6 seconds) multiplied by 10

In the example above, there are 11 or 12 complexes, in any run of 30 large squares. Rate is between 11x10 and 12x12 beats per minute.  

What is the Rhythm?
Rhythm is irregularly irregular. 
In the absence of P waves, this rhythm is AF (Atrial Fibrillation).
Follow AF guidelines. Rate not bad, but consider beta-blocker. 
BUT if you do nothing else in AF, offer anticoagulation in accordance with CHADS2 or CHADS2Vasc score.


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