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Challenges in Clinical Electrocardiography |

ST-Segment Elevation in a Patient Receiving Flecainide—Discussion

Arch Intern Med. 2011;171(1):12-13. doi:10.1001/archinte.171.1.11a.
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Drew  BJWung  SFAdams  MGPelter  MM Bedside diagnosis of myocardial ischemia with ST-segment monitoring technology: measurement issues for real-time clinical decision making and trial designs. J Electrocardiol 1998;30 ((suppl)) 157- 165
PubMed Link to Article[[XSLOpenURL/10.1016/S0022-0736(98)80067-8]]
Mittal  SRPaul  B Atrial flutter wave producing a false impression of isolated right ventricular infarction. J Electrocardiol 1999;32 (4) 371- 372
PubMed Link to Article[[XSLOpenURL/10.1016/S0022-0736(99)90009-2]]
Nabar  ARodriguez  LMTimmermans  Cvan Mechelen  RWellens  HJ Class IC antiarrhythmic drug induced atrial flutter: electrocardiographic and electrophysiological findings and their importance for long term outcome after right atrial isthmus ablation. Heart 2001;85 (4) 424- 429
PubMed Link to Article[[XSLOpenURL/10.1136/heart.85.4.424]]
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PubMed Link to Article[[XSLOpenURL/10.1001/jama.281.8.707]]
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Figure 2.

Lead aVF from the initial clinic electrocardiogram revealing flutter waves.

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Figure 3.

Leads V1and V2from the initial clinic electrocardiogram. Lead V2reveals small P waves (arrows) toward the end of the T wave. These can be traced up to V1, where every other P wave can be seen to deform the end of the QRS complex.

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Figure 4.

Rhythm tracing during administration of intravenous adenosine revealing flutter waves. There is variable AV nodal conduction resulting in decreased ventricular depolarizations (arrowheads). The atrial flutter waves (arrows) are now evident in multiple leads at a rate of approximately 200 beats/min.

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Figure 5.

Comparison of the STE segments in leads V5and V6during atrial flutter with the same patient in normal sinus rhythm. A, In the setting of atrial flutter, leads V5and V6demonstrate apparent ST-segment elevation with a straightened contour due to underlying flutter waves, resulting in the computer determination of “ST Elevation—Consider Lateral Injury or Acute Infarct.” B, With normal sinus rhythm, there is no ST-segment elevation and there is a benign appearing contour.

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