ECG Diagnosis - Sabitri, Female, 55 years

Primary Diagnosis: Narrow-Complex Tachycardia (SVT) with Demand Ischemia

Key Findings

Rhythm Interpretation

1. Atrial Flutter with 1:1 conduction - the undulating baseline in inferior leads (II, III, aVF) and the extreme rate of ~206 bpm are consistent. Classic flutter rate ~300 bpm with 1:1 conduction can appear at ~150-220 bpm.
2. AVNRT (AV Nodal Reentrant Tachycardia) - most common SVT, narrow complex, P waves typically hidden in or just after QRS.
3. AVRT (AV Reentrant Tachycardia) - accessory pathway mediated.

ST-T Changes: Diffuse Inferolateral Demand Ischemia

• ST depression in II, III, aVF (inferior), V4, V5, V6 (anterolateral) - severe, downsloping
• ST elevation in aVR - reciprocal change, classic pattern of diffuse subendocardial ischemia
• Abnormal T waves in II, aVF, V4, V5, V6

At 206 bpm, diffuse ST depression + aVR elevation most likely represents rate-related demand ischemia (Type 2 MI pattern). However, primary ACS must be ruled out once rate is controlled.

Additional Machine Conclusions

• Left Atrial Hypertrophy (P duration 339 ms - markedly prolonged; likely artifact at this rate, but underlying LA enlargement possible)
• First-degree AV block (363 ms PR - likely misidentified; needs reassessment post-conversion)
• QTc 656 ms - critically prolonged, high risk of torsades de pointes

Urgent Clinical Action Required

1. Stabilize the patient - assess hemodynamic status immediately
2. Vagal maneuvers - if hemodynamically stable (Valsalva, carotid sinus massage)
3. IV Adenosine 6 mg rapid push - diagnostic and therapeutic for SVT
4. Synchronized DC cardioversion - if hemodynamically unstable
5. Repeat ECG after rate control - reassess ST changes, true PR interval, and P wave morphology
6. Troponin I/T serial testing - to rule out ACS as primary cause
7. Electrolytes (K+, Mg2+) - correct if abnormal given prolonged QTc

Disclaimer: This ECG interpretation is for informational support only and must be confirmed by the treating physician. The report itself states: "Report needs physician confirmation."