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While on telemetry monitoring he suffered cardiacarrest and was resuscitated. What ECG finding may have contributed to (or precipitated) the cardiacarrest? Learning points : Takotsubo can lead to cardiacarrest from ventricular arrhythmia. There are no clear signs of OMI. There is a prolonged QTc.
Edited by Bracey, Meyers, Grauer, and Smith A 50-something-year-old female with a history of an unknown personality disorder and alcohol use disorder arrived via EMS following cardiacarrest with return of spontaneous circulation. T wave alternans is a harbinger of cardiac instability and TdP. (3) 2017 Oct 1;177(10):1520-1522.
This progressed to electrical storm , with incessant PolyMorphic Ventricular Tachycardia ( PMVT ) and recurrent episodes of Ventricular Fibrillation ( VFib ). The patient improved, and on Day-11 of the hospital stay — he was off inotropes and on a small dose of a ß-blocker. He required multiple defibrillations within a period of a few hours.
His prehospital ECG showed "inferior" ST depression and high voltage, with tachycardia. I suspected no OMI, that this could be due to LVH plus tachycardia. Conclusion: Type II MI probable due to hypoxia and tachycardia from resp arrest and amphetamine use. On arrival to the ED, the patient was diaphoretic, tachycardic.
Otherwise vitals after intubation were only notable for tachycardia. An initial EKG was obtained: Computer read: sinus tachycardia, early acute anterior infarct. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Heart Rhythm, 15(9): 1394-1401. [7]
2017 Mar;110(3):188-195. Type 2/3 ECG which gets converted to type 1 pattern with sodium channel blockers have 2 points. J Cardiovasc Electrophysiol. 2020 Sep;31(9):2474-2483. Gourraud JB, Barc J, Thollet A, Le Marec H, Probst V. Brugada syndrome: Diagnosis, risk stratification and management. Arch Cardiovasc Dis.
The ECG shows sinus tachycardia, a narrow, low voltage QRS with alternating amplitudes, no peaked T waves, no QT prolongation, and some minimal ST elevation in II, III, and aVF (without significant reciprocal STD or T wave inversion in aVL). It is difficult to tell if there is collapse during diastole due to the patient’s tachycardia.
Answer : you must treat the patient's underlying condition causing sinus tachycardia, and repeat the ECG at the lower heart rate. Heart 2002;87:220228 This 2017 article by Vandenberk B et al. I (Smith) measure the QT at 320 ms The Bazett-corrected QTc is divided by square root of 0.36 which is 0.6 So is it really prolonged?
There is sinus tachycardia and also a large R-wave in aVR. Drug toxicity , especially diphenhydramine , which has sodium channel blocking effects, and also anticholinergic effects which may result in sinus tachycardia, hyperthermia, delirium, and dry skin. Her temperature was 106 degrees. As part of the workup, she underwent an ECG.
CMAJ 2017 Vassallo SU, Delaney KA, Hoffman RS, et al. The relationship between J wave and ventricular tachycardia during Takotsubo cardiomyopathy. The final letter in the SLOWED mnemonic is " D " for "Dead" ( resulting from VT/VF or asystolic cardiacarrest ). Indian Pacing Electrophysiol J 2004 Antzelevitch C, Yan G.
There was never ventricular fibrillation (VF) or ventricular tachycardia (VT), no shockable rhythm. The patient was unconscious BEFORE the cardiacarrest, at the same time that she had strong pulses. Therefore, cardiacarrest is NOT the etiology of the coma. There is sinus tachycardia at ~115/minute.
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