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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. The described rhythm was an irregular, wide complex rhythm.
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 ). Hence, the IV Amiodarone was once one of the 2nd-line choices for acute pharmacologic cardioversion in such patients without hemodynamic instability.
If the rhythm converts and then reverts to tachycardia with either adenosine or electricity, Neither one of those modalities should be attempted until some longer acting pharmacological solution is given. WPW does not always have delta waves on the baseline ECG. This is called "Concealed conduction".
Figure-2: Causes of Low Voltage on ECG ( Figure reproduced from My Comment at the bottom of the page in the November 12, 2020 post in Dr. Smith's ECG Blog ). Figure reproduced from My Comment at the bottom of the page in the September 7, 2020 post in Dr. Smith's ECG Blog ). What is ELECTRICAL ALTERNANS?
mg experienced a 23% lower incidence of death from cardiovascular causes, resuscitated cardiacarrest, myocardial infarction, stroke, or urgent hospitalization for angina leading to coronary revascularization in a time-to-event analysis. 2020 Jan 28;141(4):e60] [published correction appears in Circulation. Circulation.
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