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She was awake, alert, well perfused, with normal mental status and overall unremarkable physical exam except for a regular tachycardia, possible rales at both bases, some mild RUQ abdominal tenderness. Thus, I believe it is a regular, monomorphic, wide complex tachycardia. Or it could simply still be classic VT. RVEF 100 ml/m2.
Chagas disease (ChD) was associated with increased rates of ventricular tachycardia and ventricular fibrillation in ICD patients only in the initial two periods, but there was no statistical difference in the last period. Time periods were chosen based on the establishment of the Arrhythmia Service in 2011.
Here was his initial ED ECG: There is sinus tachycardia at a rate of about 140 There is profound ST Elevation across all precordial leads, as well as I and aVL. I said I think there is a fixed stenosis in the LAD and the tachycardia and stress caused a type 2 STEMI.
There was never ventricular fibrillation (VF) or ventricular tachycardia (VT), no shockable rhythm. By ECG alone: it is suspicious for stress cardiomyopathy, or takotsubo, due to the diffuse ST Elevation: II, III, aVF AND I and aVL. Here is a similar case: Collapse, Ventricular Tachycardia, Cardioverted, Comatose on Arrival.
Whenever I see PVCs with the morphology and axis seen in todays case I always look for signs of AC ( Arrhythmogenic Cardiomyopathy ). Arrhythmogenic cardiomyopathy often manifests with PVCs from the RV. The ECG in Figure-1 however, shows no signs of arrhythmogenic cardiomyopathy.
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