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He was rushed by residents into our critical care room with a diagnosis of STEMI, and they handed me this ECG: There is sinus tachycardia with ST elevation in II, III, and aVF, as well as V4-V6. ACS and STEMI generally do not cause tachycardia unless there is cardiogenic shock. He had this ECG recorded. Are the lungs clear?
This is the ECG of a 50 yo old woman who collapsed, was found to have a pulse, but then found to be in ventricular tachycardia. Before initiating therapeutic hypothermia, a head CT was done and showed fatal subarachnoid hemorrhage. Echocardiogram showed an anteroapical wall motion abnormality. She was shocked into sinus rhythm.
The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Hopefully a repeat echocardiogram will be performed outpatient. Massive Transfusion for Motorcycle Collision with Hemorrhage, Troponin Elevated. Sinus Tachycardia ( common in any trauma patient. ).
Interpretation: There is sinus tachycardia, with right bundle branch block (RBBB). 5) Myocardial contusion (edema and hemorrhage in the myocardium) which may result in dysrhythmias, blocks (especially RBBB as here), and poor cardiac contractility, including wall motion abnormalities. She was intubated.
Here is his 12-lead: There is a wide complex tachycardia with a rate of 257, with RBBB and LPFB (right axis deviation) morphology. Read about Fascicular VT here: Idiopathic Ventricular Tachycardias for the EM Physician Case Continued He was completely stable, so adenosine was administered. See Learning point 1 below. Learning points 1.
See this case: what do you think the echocardiogram shows in this case? Systematic Assessment of the ECG in Figure-1: My Descriptive Analysis of ECG findings in Figure-1 is as follows: Sinus tachycardia at ~110/minute. A slightly prolonged QTc ( although this is difficult to assess given the tachycardia ). A normal PR interval.
An echocardiogram was done. A man in his 40s with multitrauma from motor vehicle collision Massive Transfusion for Motorcycle Collision with Hemorrhage, Troponin Elevated. Sinus Tachycardia ( common in any trauma patient. ). Is there also Brugada? Here is the result: The estimated left ventricular ejection fraction is 50 %.
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. Also consider non-hemorrhagic volume depletion, dehydration : orthostatic vitals may uncover this [see Mendu et al. (3)].
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