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

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

3. 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.

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

5. 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

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

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

8. 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.

9. 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.