A 10-day-old baby girl presents to the emergency department with a history of poor feeding and lethargy.
DESCRIPTION:
- Narrow complex (QRS duration 46 ms) tachycardia (ventricular rate 313 bpm)
- No obvious P-waves
- Rightward QRS axis (130°)
- ST-segment depression throughout the precordial leads
- T-wave inversion in the inferior leads (II, III, aVF)
INTERPRETATION:
Supraventricular tachycardia
CASE RESOLUTION:
- Initial application of ice packs to the face failed to terminate the SVT.
- Restitution of normal sinus rhythm following the second dose of intravenous adenosine.
DESCRIPTION:
- Sinus rhythm with a ventricular rate of 158 bpm
- Tall/peaked P waves (P pulmonale) indicating right atrial enlargement
- Short PR interval (96 ms)
- Rightward QRS axis (130°)
- Resolution of ST-segment and T-wave changes
- Normal QTc 424 ms
INTERPRETATION:
Normal neonatal electrocardiogram.
