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ECG Blog #436 — Bigeminy or Alternans?

Ken Grauer, MD

He developed cardiac arrest shortly after the ECG in Figure-1 was recorded. IMPRESSION: Given the presence of a wide tachycardia — with 2 distinct QRS morphologies, and no sign of P waves — a presumed diagnosis of B i D irectional Ventricular Tachycardia has to be made. What is the most likely cause of this arrhythmia?

Blog 161
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Early repolarization in the left posterior leads of the electrocardiogram: A new challenge for the existence of idiopathic ventricular fibrillation

HeartRhythm

A few decades ago all sudden cardiac arrests with documented ventricular fibrillation (VF) and structurally normal hearts were diagnosed as idiopathic ventricular fibrillation (IVF).

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Flecainide Is Associated With a Lower Incidence of Arrhythmic Events in a Large Cohort of Patients With Catecholaminergic Polymorphic Ventricular Tachycardia

Circulation

BACKGROUND:In severely affected patients with catecholaminergic polymorphic ventricular tachycardia, beta-blockers are often insufficiently protective. The primary end point was AEs, defined as sudden cardiac death, sudden cardiac arrest, appropriate implantable cardioverter defibrillator shock, and arrhythmic syncope.

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Brugada Syndrome: Diagnosis and Risk Stratification

All About Cardiovascular System and Disorders

Brugada syndrome is thought to account for about one fourth of sudden cardiac deaths in individuals with structurally normal heart. Even though mutations in other channels have been described in Brugada syndrome, only those in SCN5A gene are considered to be definitely disease causing. mV or R/q ≥ 0.75.

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Hyperthermia and ST Elevation

Dr. Smith's ECG Blog

Otherwise vitals after intubation were only notable for tachycardia. An initial EKG was obtained: Computer read: sinus tachycardia, early acute anterior infarct. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death.

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A young F is hyperthermic, delirious, and dry: Fever-induced Brugada? Diphenhydramine toxicity? Tricyclic?

Dr. Smith's ECG Blog

There is sinus tachycardia and also a large R-wave in aVR. Drug toxicity , especially diphenhydramine , which has sodium channel blocking effects, and also anticholinergic effects which may result in sinus tachycardia, hyperthermia, delirium, and dry skin. Her temperature was 106 degrees. As part of the workup, she underwent an ECG.