This ECG is from a 49 year old with chest pain.
|Click to enlarge|
- PR - Normal (~160ms)
- QRS - Normal (100ms)
- QT - 400ms (QTc Bazette ~420-430 ms)
- ST Depression I, II, III
- P Wave Inversion Lead I
- Ectopic Atrial Rythm with ischaemic features
- Ventricular Ectopic with 'R-onT' phenomenon
- Polymorphic VT --> VF
- Acute myocardial ischaemia / infarction causing polymorphic VT / VF
- Received 4 x 200J shocks
- 150mg iv amiodarone
- 100 mg iv lignocaine
Subsequent ROSC was achieved after < 10 minutes.
Post ROSC ECG showed antero-lateral ST elevation.
The patient underwent inter-hospital transfer for PCI.PCI revealed a proximal LAD lesion with 90% occlusion, which was stented.
- Normal LV size with anterior, septal and apical akinesis and overall moderate systolic impairment
- Probable LV apical thrombus
- Normal right ventricular size and apical akinesis and overall mild systolic impairment.
Things to think about
- The role of early revascularisation with thrombolysis prior to inter-hospital transfer
- The role of lignocaine in shock refractory VT/VF
- Several International Guidelines on ALS are linked to below and the recommendations on the use of lignocaine vary between guidelines
References / Further Reading
International Resuscitation Guidelines
- Australian Resuscitation Council Guidelines here
- UK Resuscitation Council Guidelines here
- American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science 2010 Edition here
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.