Unusual presentation….

An otherwise well 60 year old man, DC, presents with palpitations whilst out walking three hours ago.  He admits to mild chest tightness.  He denies any history of fever, cough, chest pain or breathlessness.  A 12 lead ECG is taken and is as below.  What is the rhythm?  How can you be sure? How will you treat it?








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What happened next? [expand title=”Open” swaptitle=”Close”]

DC continues to feel palpitations and mild chest tightness.  He is given oxygen and put into Resuscitation, where 6mg of IV adenosine via  a cannula in his cubital fossa confirms that he is in atrial flutter.  His chest tightness persists despite oxygen and half an anginine.  His BP is 100/65.  As he has eaten recently but has only been in atrial flutter for a few hours, he is sedated with ketamine and cardioverted to sinus rhythm with 50 joules.







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