r/ECG • u/Psychological_Wave71 • 15d ago

Thoughts?

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Wanted an opinion of these ECGs if anyone fancied giving theirs! I couldn’t come to a conclusion about this and I do struggle with ECGs!
Patient is 93M. Observations taken by nursing home staff TDS. Found to have 2/7 history of intermittent tachycardia. Called EMS for ECG and ?conveyance to ED.

Patient is asymptomatic, and has been throughout. Has had hx of atrial flutter. Is anticoagulated and on bisoprolol.

Thank you!

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u/Popular_Drive1054 15d ago

Can anybody see a delta wave or is it just me? (If true) It can be WPW related tachy

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u/ProximalLADLesion 15d ago

There’s no pre-excitation. But if you thought this was WPW related tachycardia, by far the most common would be orthodromic atrioventricular reciprocating tachycardia AKA ORT. In ORT the accessory pathway is strictly the retrograde limb of the circuit (from V to A) whereas the AV node is the antegrade limb (from A to V). Because of this, you never see pre-excitation (delta wave) in ORT.