History:
This ECG was recorded from a 50 year-old man presented with sudden onset SOB.
ECG shows:
Atypical (clockwise) Atrial flutter with 5:1 AV block
-Atrial rate 300/min, no change in p waves morphologies
-Notice flutter waves are positively directed in lead II, different to flutter waves of typical atrial flutter where the flutter waves are negatively directed.
-Regular ventricular rate 60/min
Normal axis, QRS duration, QT for rate
Poor R wave progression, deep Q waves in V1-6, suggestive of an old anterior MI
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