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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? Note: The patient while on telemetry had alternating atrialfibrillation, sinus rhythm with 1st degree AV block and also periods of Wenckebach conduction.
Patient had an unwitnessed cardiacarrest without bystander CPR performed. Initial vitals show hypertension (175/85), AtrialFibrillation with RVR as seen in Figure 1 , hypercapnia (99mmHg), and SPO2 of 100%. After 5 minutes post-ROSC, the atrialfibrillation converted to a sinus rhythm.
Written by Pendell Meyers First try to interpret this ECG with no clinical context: The ECG shows an irregularly irregular rhythm, therefore almost certainly atrialfibrillation. After an initially narrow QRS, there is a very large abnormal extra wave at the end of the QRS complex. Is there a long QT? How would you manage this patient?
AtrialFibrillationAtrialfibrillation causes irregular heartbeat, and the heart's normal blood supply is affected. Since atrialfibrillation can also be intermittent, such patients should continuously monitor their heart activity while performing daily activities with a portable ECG device.
The rhythm now is atrialfibrillation. This patient is actively dying from a left main coronary artery OMI and cardiacarrest from VT/VF or PEA is imminent! Complete LMCA occlusion is associated with clinical shock and/or cardiacarrest. A repeat ECG was recorded about 15 minutes after the initial ECG.
Osborn waves have been reported with hypercalcemia, brain injury, subarachnoid hemorrhage, Brugada syndrome, cardiacarrest from VFib — and — severe, acute ischemia resulting in acute MI ( See My Comment in the November 22, 2019 post on Dr. Smith’s Blog ). Rituparna et al — as well as Chauhan and Brahma ( Int.
There is also bradycardia. Bradycardia puts patients at risk for "pause-dependent" Torsades de Pointes. Torsades in acquired long QT is much more likely in bradycardia because the QT interval following a long pause is longer still. There is atrialfibrillation. If cardiacarrest from hypokalemia is imminent (i.e.,
Another frequent feature of hypothermia is atrialfibrillation (not seen in this case) Core temperature of this patient was 29,5 Celsius. Smith: This bizarre ECG looks like a post cardiacarrest ECG with probable acidosis or hyperkalemia in addition to OMI. Troponins were negative in serial blood tests. Potassium 4,6.
The rule of thumb is less accurate, and the risk is higher because a long QT in the presence of bradycardia ("pause dependent" Torsades) predisposes to Torsades. 6) Use a different rule of thumb for bradycardia : Manually approximate both the QT and the RR interval. 3) At heart rates below 60, far more caution is due. Musat DL et al.
This ECG shows a sinus bradycardia with a normal conduction pattern (normal PR, normal QRS, and normal QTc), normal axis, normal R-wave progression, normal voltages. Hypothermia can also produce bradycardia and J waves, with a pseudo-STEMI pattern. There is marked sinus bradycardia. What do you think? As per Drs.
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