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For example — marked bradycardia with unusual forms of advanced AV block — or marked bradycardia without evident P waves — or marked QRS widening with "shapeless" morphology — are all ECG indication of the need for immediate IV calcium until improvement of these ECG patterns. We do not know for certain what the rhythm was?
If a patient presents with chest pain and a normal heart rate, or with shockable cardiacarrest, then ischemic appearing ST elevation is STEMI until proven otherwise. CLICK HERE — for the ESC/ACC/AHA/WHF 2018 Consensus Document on the 4th Universal Definition of MI, in which these concepts are discussed and illustrated.
Patient had an unwitnessed cardiacarrest without bystander CPR performed. Crew notifies the received ED of an incoming post-arrest patient and notes a sinus bradycardia on their monitor, as seen in Figure 2. Figure 2 : This rhythm shows a sinus bradycardia at a rate between 30 and 40bpm.
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. If cardiacarrest from hypokalemia is imminent (i.e., mEq/L, from 1.9
In both tracings — an exceedingly fast PMVT is documented. There was no evidence bradycardia leading up to the runs of PMVT ( as tends to occur with Torsades ). Principal adverse cardiac effects of Quinidine include QRS widening and QTc prolongation. That said — there is no evidence on ECG of re-occlusion of the infarct artery.
Our patient had a Brugada Type 1 pattern elicited by an elevated core temperature, which is also a documented phenomenon. Drugs that have been associated with Brugada ECG patterns include tricyclic antidepressants, anesthetics, cocaine , methadone, antihistamines, electrolyte derangements, and even tramadol. [2].
Thus, Brugada is the likely diagnosis _ A very nice explanation of this is given in the document quoted below on current ECG criteria for Brugada pattern. Further history later: This patient personally has no further high risk features (syncope / presyncope), but her mother had sudden cardiacarrest in sleep.
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