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That said — rhythm interpretation here is more of an academic interest — as the most striking findings are the widespread T-wave inversions and QT prolongation. Learning points : Takotsubo can lead to cardiac arrest from ventricular arrhythmia. The patient was diagnosed with stress cardiomyopathy.
There are 3 etiologies I always think of with bradycardia and AV block: 1. In the interest of academic discussion Ill present a nother p erspective on selected aspects this case. In my experience the aspect of interpretation that computer algorithms do most poorly in, is interpretation of complex arrhythmias. Hyperkalemia.
Therefore, she underwent temporary pacemaker placement and overdrive pacing at a rate of 90 bpm to keep the heart rate up in order to prevent these PVCs triggering ventricular arrhythmia. Hypokalemia was unlikely because she continued to have ventricular arrhythmia despite of correcting electrolytes.
The patient later settled into sinus bradycardia. The amiodarone was discontinued and the patient did well. == MY Comment , by K EN G RAUER, MD ( 6/23 /2023 ): == From an academic standpoint — I love WCT ( W ide- C omplex T achycardia ) rhythms. I focus my comments on some additional thoughts that add to his excellent discussion.
Additionally, her beta-blocker dose had been decreased because of bradycardia, further predisposing her to atrial flutter. During hospital admission she had a variety of atrial arrhythmias, which eventually resolved, likely due to her decreasing flecainide level.
However, he suddenly developed a series of malignant ventricular arrhythmias. Below are printouts of some of the arrhythmias recorded. This time, the arrhythmia did not spontaneously terminate — but rather degenerated to VFib, requiring defibrillation. The arrhythmia starts with a PVC having a short coupling interval.
PVCs N ot generally considered abnormal ECG findings: Isolated PAC, First Degree AV Block, Sinus bradycardia at a rate of 35-45, and Nonspecific ST-T abnormalities (even if different from a previous ECG). Thus, if there is documented sinus bradycardia, and no suspicion of high grade AV block, at the time of the syncope, this is very useful.
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