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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.
Since the patient was stable and tolerating the arrhythmia it was decided to treat with IV Amiodarone for medical conversion. 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 ). Smith : What do you think?
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?
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.
I focus my comments purely on a few sophisticated concepts in arrhythmia recognition — fully aware that specific rhythm disorders with calcium channel toxicity need not be treated per se, beyond providing cardiovascular support. It's always rewarding and mutually educational to discuss interesting aspects of arrhythmia interpretation.
He has a family history concerning for arrhythmia. Given the circumstances of his car crash, we presume it was due to an underlying arrhythmia. He has a family history concerning for arrhythmia with his father requiring some sort of device (PPM, ICD, unclear) at a young age.
With the history of Afib, CTA abdomen was ordered to r/o mesenteric ischemia vs ischemic colitis vs small bowel obstruction. Thirty-six patients (36%) presented with cardiacarrest, and 78% (28/36) underwent emergent angiography. See this case: what do you think the echocardiogram shows in 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 ).
This causes deadly arrhythmias and should be considered in patients with syncope and short QT 2. 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.
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