Friday, 19 April 2013

ECG of the Week - 22nd April 2013

This ECG is from a 78 yr old male who presented with a 2 day history of lethargy and dizziness

 He has a history of ischaemic heart disease, type 2 DM, hypertension, and chronic renal failure. 
Medications include calcium-channel blocker, beta-blocker, and ACE-inhibitor.

 Conscious with systolic BP of 70 !



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5 comments:

  1. Brian19 April 2013 at 18:43

    HR approx 42BPM
    No p waves seen
    Regularly irregular

    LAD

    Narrow complex QRS followed by wider complex QRS
    Junctional bradycardia with ventricular bigeminy

    TWI inferior leads

    Symptomatic unstable bradycardia

    Needs pacemaker

    Junctional bradycardia
    Ventricular bigeminy

    Possible inferior NSTEMI

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  2. Christopher19 April 2013 at 19:52

    Rate: 50 bpm due to bigeminy, possibly 25 bpm (but "conscious" would suggest otherwise.
    Regularity: regular, pattern of bigeminy
    P-waves: retrograde P-waves seen during bigeminal beats, no evidence of AF during long pauses. Appears to be an atrial standstill.
    PRi: none
    QRSd: narrow, bigeminal beats aren't very wide either

    Axis: Normal
    QTi/QTc: Normal
    ST/T-waves: widespread depression and TWI with some ST-E in aVR

    Rhythm: Yikes. Junctional rhythm with what seems to be bigeminal PVCs (or perhaps even PJCs w/ aberrancy). No automatic atrial activity.

    DDx: DIE(SSS) (stolen from VinceD). Drugs, Ischemia, Electrolytes, and Sick Sinus Syndrome. Top on my list are drugs and lytes, followed by ischemia and least likely seems to be SSS. The ST-changes are probably demand related, given the pattern they're seen in.

    Very interesting case!

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  3. Brian19 April 2013 at 20:58

    Strike the comment on LAD - eyes strayed to the bigeminal beats.

    ReplyDelete
  4. Brian19 April 2013 at 20:59

    Check K

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  5. Unknown19 April 2013 at 22:20

    Absolutely on the lytes / K, the treating team thought so and urgent VBG was obtained:

    pH 7.041
    Bicarb 6.9

    K 6.0

    K not too bad but very acidaemic

    JL

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