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- Mean ventricular rate ~66 bpm
- Atrial activity rate ~68 bpm
- Regular atrial activity
- Sinus rhythm
- Regular unifocal PVC's
- Pattern - P-QRS, P-QRS, PVC
- Full compensatory associated with PVCs
- Sinus complexes - LAD
- PVCs - Normal
- PR - Prolonged (~210ms)
- QRS - Prolonged (180ms)
- QT - 440ms
- QRS - Prolonged (160ms)
- QT - 400ms
- Sinus complexes - Discordant ST segment & T wave changes
- ST Elevation leads III, aVF, aVR, V1-4
- ST Depression leads I, aVL, V6
- T wave inversion leads I, II, aVL
- LBBB Morphology - sinus complexes
- P waves broad (120ms) and notched lead II
- Intra-atrial block
- Trigeminy
- LBBB
- 1st Degree AV Block
This patient presented with severe cardiac failure and an out-of-hospital collapse. The ECG features of LBBB and 1st degree AV block were longstanding with no acute change in the LBBB morphology.
The patient had a normal potassium but was profoundly acidotic, ABG below :
- pH 6.9
- pCO2 90 [mmHg]
- PO2 96 [mmHg]
- HCO3 18 [mmol/L]
- Lactate 11 [mmol/L]
- Anion Gap 17 [mmol/L]
Previous ECHO, over 12 month prior, had shown the following:
- Dilated LV with inferolateral akinesis
- Severe LV impairment
- Severe mitral regurgitation
- Severely dilated left atrium
- Severe pulmonary hypertension
Last angiogram, over 12 month prior, showed:
- LAD - 70% proximal stenosis
- RCA - 30% proximal stenosis, 50% distal stenosis
Given associated extensive co-morbidites and previous unsuitability for invasive treatment management focused on symtpomatic relief and comfort measures only.
References / Further Reading
Life in the Fast Lane
Textbook
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.
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