Cor Pulmonale: COAD with MAT

Possible Run of MAT

Report:

Sinus tachycardia 118/min

Right atrial abnormality

SVEBs, one blocked

Probable run of multifocal atrial tachycardia (MAT) 170/min

Probable LBBB aberrancy

Right axis deviation +100o

Left ventricular hypertrophy voltage

Comment:

The ectopic tachycardia consists of seven beats at the end of the recording. Four of the complexes are broad and are, probably, an expression of phasically aberrant LBBB conduction. Note a narrow QRS before the last beat, with a cycle as short as any in this trace: this is not a simple rate-dependent LBBB in the broad beats. The broad beats may also be VEBs – one would like to see them in V1 before reaching the final diagnosis.

The RAA is the classical, peaked, P pulmonale of old, 4 mm tall and with frontal plane axis of +80o.

The RAD in COAD is not always a result of anatomical right ventricular hypertrophy; this patient’s axis was normal, albeit rightward, three days previously, before the current deterioration (Fig 176a below).

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