Check out the comments from our original post here.
|Click to enlarge|
Lead II Rhythm Strip - Total time 20 seconds
- ~95 bpm
- Lots of baseline artifact
- Unable to assess
- PR - Normal (~200ms)
- QRS - Normal (100ms)
- QT - 360ms (QTc Bazette 450-460 ms)
- ST elevation <1mm
- Initiation of PVT / VF 3 seconds prior to end of rhythm strip
- Short-long cycle initiation secondary to PVC
- PMVT/VF with QTc Prolongation
Pre-hospital the patient underwent successful DC cardioversion. On arrival to the Emergency Department the patient has ongoing chest pain and a further 3 episodes of PVT/VF which responded to DC cardioversion.
ECGs whilst in the Emergency Department did not show definitive ST segment changes but
the patient's medications included amlodipine which was ceased on admission.
Coronary angiogram showed:
- RCA - Dominant - 30% proximal lesion
- LMCA - Normal
- LAD - 60% proximal
- LCx - distal 80% - stented
- Antero-apical hypokinesis
- Preserved LV function
In the setting of QT prolongation refractory VT/VF can be difficult to treat and urgent cardiology input in advised, in these settings amiodarone can further prolong the QT and should be avoided. Underlying causes need to be corrected including ceasing drugs known to prolong QT, correcting electrolyte abnormalities, and treating ischaemia.
References / Further Reading
- Australian Resuscitation Council - Managing Acute Dysrhythmias - here
Life in the Fast Lane
- QT Interval here
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.