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She was successfully revived after several rounds of ACLS including defibrillation and amiodarone. An Initial ECG was performed: Initial ECG: Sinus tachycardia with prolonged QT interval (QTc of 534 ms by Bazett). In particular — QRS alternans during narrow SVT rhythms has been associated with reentry tachycardias.
That occurs in right heart failure and constrictive pericarditis. Constrictive pericarditis is an important cause for Kussmaul sign or inspiratory increase in jugular venous pressure. On the other hand, the Y descent is very prominent in constrictive pericarditis, and it is known as Friedreich’s sign.
We can see enough to make out that the rhythm is sinus tachycardia. Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). A bedside ultrasound should be done to assess volume and other etiologies of tachycardia, but if no cause of type 2 MI is found, the cath lab should be activated NOW.
It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. Dyspnea, Chest pain, Tachypneic, Ill appearing: Bedside Cardiac Echo gives the Diagnosis 31 Year Old Male with RUQ Pain and a History of Pericarditis. Tachycardia is of course, quite common in patients following cardiac arrest.
After epinephrine, atropine, and defibrillation x 2, there was a return of pulses. Myocardial rupture is usually preceded by postinfarction regional pericarditis (PIRP). A 65 yo woman had felt ill for 36 hours, had seen her MD but without undergoing a cardiac evaluation. She collapsed and 911 was called; she was found pulseless.
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