A weekly ECG / EKG review blog looking at some interesting ECG's from the world of Emergency Medicine.
I'll cover the left third first.Rate: ~70 bpmRegularity: regularP-waves: Inverted in I, upright in II/III.PRi: ~180ms, associated 1:1.QRSd: Narrow, ~100msQTc: normal (<1/2 RR)P Axis: Rightward, left atrial focus or lead misplacementQRS Axis: NormalST/T-waves: downsloping ST-segments w/ ST-depression consistent with ischemiaRhythm: ectopic atrial rhythm (or sinus rhythm with lead misplacement)Right two-thirds:Early coupled PVC (+aVR) initiating PMVT devolving into primary VF. Not calling TdP due to normal QTc prior to initiation. Given ST/T-wave changes and patient complaint we should consider an ischemic cause of this event.Dx: ectopic atrial rhythm with PVC initiating PMVT/VF due to ischemia (ACS).Rx: defibrillation, consider an antiarrhythmic. Confirm lead placement once arrhythmias are taken care of.
my post vanished, or perhaps I did not submit it properly few days ago... anyway.... once again.initally I,II,III regular rythm ~ 70/min. However P wave inversion in I is against Sinus Rythm Criteria. Therefore either incorrectly placed leads (right-left arm) or less likely but possible dextrocardia. So check the leads to exclude technical error and listen to the heart :)P mitrale in III, but again lets check the leads! Then polymorphic looking VT, which suggests Torsade de Pointes with ventricular rate ~ 300/min. QT does not look overtly prolonged, so wldn't expect a long QTc.Chest pain and polymorphic VT, still ACS high on my list, especially with those ST depressions in I,II. Also low Mg?Hypomagnesemia/ hypokalemia? I would give 2g of Magnesium anyway. Patient by definition is unstable (as per ALS) because has chest pain, so electricity 200J.... and call Cardiology :)Had a patient once who was given amiodarone for TdP by Physicans. (after Mg of course:)