ECG Case 001

Inspired by Vince D. 

70 year old man with recent diagnosis of hyperthyroidism walks into the ED with palpitations. Has had them since the hyperthyroidism started but states something changed a few hours ago and now he feels a bit light headed with them.

Vitals are all stable, and the patient looks well.

His ECG looks like this:

Atrial Flutter 01


Click for answer

What happened?

What happened next?

How often does adenosine convert Atrial Flutter?


About Andy Neill

EM Reg/Resident based near Dublin. Former anatomy lecturer, theology student and occasional musician @andyneill | + Andy Neill | Contact


  1. It looks like a PVC interrupts the flutter circuit, pretty neat.

  2. This is neat and I have thought of it at times and done it once or twice. But then I have started thinking I might be skyrocketing an (atrial) thrombus -- they say it’s the converting to sinus process that bears the most risk, not the electroconversion. Call me a wooze but I don’t think I can do this with a genuine smile until the statistics tell me it’s ok!

  3. It happened on a patient we were treating today! -- the first time in my experience and that of my colleagues (which probably adds up into the hundreds)


  1. […] ECG Case 001 -- Is it sinus tachy, AF or A-flutt -- you be the judge! […]

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