Sinus rhythm will always have some variation, both beat to beat with breathing, and over time with interventions like pain control and fluids. So how can sure that this is atrial flutter? Placing this patient on a monitor and watching that monitored rhythm almost confirms that this is NOT sinus rhythm. The waves in Lead III however do more closely resemble typical flutter waves: These are actually flutter waves that can easily be mistaken for p-waves of sinus node origin if the EKG is not closely examined.
Upon initially viewing this EKG, you might be inclined to believe that this is sinus rhythm because in some leads, especially lead V3, there is a deflection that looks very similar to a “p-wave.” But is this a true p-wave coming from the sinus node, or is this actually a flutter wave that just looks like a “p-wave?” RHYTHM: Regular w/ p waves always followed by QRS complex, QRS complex always preceded by P wave Axis approximately +120 degrees (most isoelectric lead AvR, -150 degrees, axis must be approximately 90 degrees from most isoelectric lead, with I being negative, axis must be around +120 degrees). ANSWER: This EKG shows ATRIAL FLUTTER with 2:1 conductionĪXIS: Slight right axis deviation (I-, II +, III+).
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