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Permanent pacer placement Later, a biventricular pacer was placed for " Cardiac Resynchronization Therapy (CRT) " (This is indicated for patients with LBBB and QRS duration > 130 ms and heartfailure and vastly improves heartfailure). Even with tachycardia and a paced QRS duration of ~0.16 J Am Coll Cardiol.
See here for management of Polymorphic Ventricular Tachycardia , which includes Torsades. Could the dysrhythmias have been prevented? Severe hypokalemia in the setting of STEMI or dysrhythmias is life-threatening and needs very rapid treatment. Heartfailure leading to death was related to all subclasses of PVC.
Opinions vary widely on the K level at which a patient must be admitted on a monitor because of the risk of ventricular dysrhythmias. My rationale is that if the K is affecting the ECG, then it is affecting the electrical milieu and can result in serious dysrhythmias. Until some real data is available, my opinion is this: 1.
In cardiogenic shock, fluid may worsen the pulmonary edema associated with acute heartfailure, but may still be required to support the hemodynamic status of the patient. Hypotension may of course be a result of a brady- or tachydysrhythmia. 2) Hypoxia, including poisons of oxidative phosphorylation such as HS, CO, CN.
Here was his ED ECG: There is sinus tachycardia (rate about 114) with nonspecific ST-T abnormalities. NT-proBNP values less than 300 pg/ml have a 99% negative predictive value for excluding congestive heartfailure. A cutoff of 1200 pg/ml for patients with a normal eGFR is very specific for heartfailure.
If the patient has Abnormal Vital Signs (fever, hypotension, tachycardia, or tachypnea, or hypoxemia), then these are the primary issue to address, as there is ongoing pathology which must be identified. to 22.7), a history of congestive heartfailure (OR: 5.3, Most physicians will automatically be worried about these symptoms.
Smith comments : Wide complex tachycardia. The differential diagnosis of WCT is: 1) Sinus tachycardia with "aberrancy" (in this case RBBB and LAFB), but there are no P-waves and the QRS morphology is not typical of simple RBBB/LAFB. Also, if the rate is constant, not wavering up and down, it is highly unlikely to be sinus tachycardia.
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