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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.
We periodically review this intriguing ECG finding that is best known for its association with hypothermia — but which may also be seen in association with a number of other entities, including acute infarction and cardiacarrest. My Comment addresses a few additional aspects of this phenomenon. Baseline artifact is no longer present.
NOTE: The ECGs in today's case are recorded in the Cabrera Format ( See Dr. Grauer Comment in the October 26, 2020 post of Dr. Smith's ECG Blog for review on the Cabrera Format ). KEY Point: Nothing other than AFib with WPW results in a ventricular response this fast ( which is why Figure-2 is pathognomonic for AFib in a patient with WPW ).
Some patients have baseline RBBB with LAFB, but in patients with likely ACS, these are associated with severe infarction with cardiacarrest, cardiogenic shock or impending shock. Suffice it to say that, "The heart does whatever it will do when a patient is about to arrest". RBBB + LAFB in the setting of ACS is very bad.
Blood was drawn , and the patient was promptly placed in a room to be seen — but on entering, the ED physician found her unresponsive in cardiacarrest. Do you see any indication on this ECG of WHY this patient was about to arrest? Is there any indication on this ECG of WHY this patient shortly after had a cardiacarrest?
For more on my systematic approach — Check out My Comment in the May 3, 2020 post ). Smith’s ECG Blog: SQTS is an inherited cardiac channelopathy determined by the presence of symptoms ( syncope, cardiacarrest ) — positive family history — and the ECG finding of an abnormally short QTc interval.
At some point ~1-2 hours after the initial ECG — the patient developed runs of VT, leading to cardiacarrest. The importance of the new OMI ( vs the old STEMI ) Paradigm — See My Comment in the July 31, 2020 post in Dr. Smith's ECG Blog. He could not be resuscitated. There are lessons to be learned from this case.
See these other related cases: A patient with cardiacarrest, ROSC, and right bundle branch block (RBBB). Rather than AFib I suspect we are seeing a sinoventricular rhythm in ECG #1 with some sinus arrhythmia. Is this just right bundle branch block? large boxes, but then decreases and remains slightly irregular ).
Smith’s ECG Blog: SQTS is an inherited cardiac channelopathy determined by the presence of symptoms ( syncope, cardiacarrest ) — positive family history — and the ECG finding of an abnormally short QTc interval. SQTS is a relatively new diagnosis that has only been recognized as a distinct clinical entity since 2000.
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