我不相信只有我這麼吃這個粉專的幽默😂😂😂😂

註1：Flecainide，氟卡胺，一種心血管系統藥。
註2：WPW症候群，一種房室迴旋頻脈症（Atrioventricular reentrant tachycardia，AVRT）心率不整；又因WPW是在1930年被3位醫師(Dr Wolff、Dr Parkinson、Dr White) 發現，因此又被稱為沃爾夫巴金森懷特氏症候群 (Wolff-Parkinson-White Syndrome) ，取三位醫師名字的首個字母簡稱 WPW。

Hahahaha

ECG 診斷：

Atrial flutter with 2:1 and 3:1 block

Circulation ECG Challenge Response! Regarding the 56 year old woman with AF and palpitations:

Diagnosis: atrial flutter with 2:1 and 3:1 AV block

There is a regular rhythm at a rate of 130 bpm. There are several longer RR intervals (↔). The QRS complex duration is normal (0.08 sec) and the morphology is normal. The axis is normal between 0° and +90° (positive QRS complex in leads I and aVF). The QT/QTc intervals are normal (280/410 msec). There are P waves seen, primarily in lead V1 (+) and there is a short RP (┌┐) and long PR (└┘) interval. Etiologies for a short RP interval include:
1. sinus tachycardia
2. atrial tachycardia
3. ectopic junctional tachycardia
4. atrial flutter with 2:1 AV conduction
5. typical atrioventricular nodal repentant tachycardia (unusual variant termed slow-slow)
6. atrioventricular reentrant tachycardia
During the longer RR intervals (↔) two sequential P waves can be seen (+, ^). They have a stable PP interval at a rate of 260 bpm. The only atrial arrhythmia that has a regular rate ≥260 bpm is atrial flutter. Therefore there is 2:1 and 3:1 AV block.

ECG Diagnosis: Atrial tachycardia

Circulation ECG Challenge Response! Regarding the 25 year old woman with palpitations:

Diagnosis: Atrial tachycardia

The rhythm is regular, except for one long RR interval. The initial rate is 140 bpm and is followed by several complexes at a rate of 100 bpm. The QRS complex has a normal duration (0.08 sec) and morphology. The axis is normal between 0° and +90° (positive QRS complex in lead I and aVF). The QT/QTc intervals are normal (320/430 msec). There are no P waves before the first 10 QRS complexes and last 6 QRS complexes; there however P waves (+) noted after each of these QRS complexes with a long RP interval (└┘) and short PR interval (┌┐). The P waves are negative in leads II and aVF. This is a long RP tachycardia, There is a P wave before each of the next 4 QRS complexes (i.e. complexes 11-14) (*) with a stable PR interval (0.16 sec). This is a normal sinus rhythm. The etiologies for a long RP tachycardia include a sinus tachycardia (no the cause as the P waves are negative in leads II and aVF), an ectopic junctional tachycardia, atrial tachycardia, atrial flutter with 2:1 AV block or conduction, atypical atrioventricular nodal reentrant tachycardia (i.e. fast-slow), or an atrioventricular reentrant tachycardia. The arrhythmia terminates abruptly without a P wave (↑). This is the way atrial arrhythmias terminate. Therefore this is most likely atrial tachycardia. As there is only one P wave seen this is not atrial flutter. The P wave is different from the sinus P wave and is negative in leads II and aVF) and this is not sinus tachycardia. Arrhythmias generated within or require the AV node terminate with a non conducted P wave.