Answer for August 28, 2013
his is a very fast narrow complex tachycardia (rate 240-270). Physiologic block at the AV node usually does not permit rates this fast (usual max 180-200 in adults). This may be from a child or occasionally a re-entrant tachycardia or enhanced autometicity tachycardia may occur in an adult. Atrial flutter with 1:1 conduction is another possibility. There is diffuse ST segment “rate-related” ST segment depression. This may be just due to the rate or may reflect ischemia. Treatment involves vagal maneuvers, or adenosine or cardioversion if the patient is unstable (as s/he is likely to be).
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