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It's a very "fun" ECG, with initial ectopic atrial tachycardia (negative P waves in inferior leads conducting 1:1 with the QRSs), followed by spontaneous resolution to sinus rhythm. The emergent echocardiogram showed normal EF, no WMA, and normal valve function. What About the Tachycardia? Triage ECG: What do you think?
The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Hopefully a repeat echocardiogram will be performed outpatient. 2015, March 1). Sinus Tachycardia ( common in any trauma patient. ). He was intubated for altered mental status. 2300: QRS now within normal limits.
A transthoracic echocardiogram showed an LV EF of less than 15%, critically severe aortic stenosis , severe LVH , and a small LV cavity. 2015 Oct; 66(4):355-362. Aortic angiogram did not reveal aortic dissection. The patient was transported to the CCU for further medical optimization where a pulmonary artery catheter was placed.
The status of the patients chest pain at this time is unknown : EKG 1, 1300: There is sinus tachycardia and artifact of low and high frequency. However, there is also significant tachycardia , with heart rate of 116, and known hypoxia. She arrived to the ED with a nonrebreather mask. Her blood pressure on arrival was 153/69.
If the patient has Abnormal Vital Signs (fever, hypotension, tachycardia, or tachypnea, or hypoxemia), then these are the primary issue to address, as there is ongoing pathology which must be identified. Annals of Emergency Medicine March 2015 ; Volume 65, Issue 3, Pages 268–276.e6 18) Venkatesh Thiruganasambandamoorthy et al.
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