1. Stepwise interpretation of ECG
ID 122
Atrial flutter

2. ID 122 – 50 year old man complaining of palpitation

3. ID 122 – 50 year old man complaining of palpitation
Can you see P waves?

4. ID 122 – Atrial flutter with variable AV block – Ventricular rate 107/min.
We can see typical waves of atrial flutter with variable AV block – ventricular rate = 107/min.

5. ID 122 – Atrial flutter with variable AV block – Ventricular rate 107/min.
Let’s now look at the QRS complex. It is positive in I and slightly positive or isoelectric in aVF –
The QRS axis is normal.

6. ID 122 – Atrial flutter with variable AV block – Ventricular rate 107/min.
The QRS duration is normal – There are no signs of right or left bundle branch block
or nonspecific block

7. ID 122 – Atrial flutter with variable AV block – Ventricular rate 107/min.
There no signs of right or left ventricular hypertrophy

8. ID 122 – Atrial flutter with variable AV block – Ventricular rate 107/min.
The QRS shows no signs of myocardial infarction

9. ID 122 – Atrial flutter with variable AV block – Ventricular rate 107/min.
Because of the saw-like waves of atrial flutter, it is difficult to assess the T waves in the
inferior leads and V6. In the other leads the T waves are normal.

10. ID 122 - Final diagnosis - Atrial flutter with variable AV block – Ventricular rate 107/min.
Because of the saw-toothed waves of atrial flutter, it is difficult to assess the T waves in the
inferior leads and V6. In the other leads the T waves are normal.