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Discontinue all negative chronotropic agents, since the risk of torsade is much higher with bradycardia or pauses. See this post: How a pause can cause cardiacarrest 2. There is ventricular bigeminy with bizarre appearing wide T-waves See even more striking cases of this at the bottom of the post. The plan: 1.
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. Could the dysrhythmias have been prevented? mEq/L, and 10 mEq would increase it by 3.3
The limb lead abnormalities appear to be part of the Brugada pattern, as described in this article: Inferior and Lateral Electrocardiographic RepolarizationAbnormalities in Brugada Syndrome Discussion Brugada Type 1 ECG changes are associated with sudden cardiac death (SCD) and the occurrence of ventricular dysrhythmias.
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