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- 48 bpm mean ventricular rate
- Nil p waves visible
- Right axis deviation
- QRS - Normal (100ms)
- QT - 480ms
- ST Depression leads II, III, aVF, V2, V3
- Biphasic T wave inversion leads II, III, aVF
- T wave inversion leads V2/3
- Prominent R waves in all precordial leads
- R/S >/=1 leads V1-3,V5-6
- Broad differentials:
- Drug toxicity esp digoxin
What happened ?The patient was transferred to CCU for ongoing investigation and management.The patient remained in 'slow' AF with limited exercise rate response and a single chamber PPM was inserted. The rash was felt to be secondary to chemotherapy and resolved with cessation of lenalidomide.
Chemotherapy related cardiotoxicity
The following are two nice review articles looking at the various manifestations of cardiotoxicity as they related to chemotherapeutic drug use.
- Bovelli D,Plataniotis G, Roila F, on behalf of the ESMO Guidelines Working Group. Cardiotoxicity of chemotherapeutic agents and radiotherapy-related heart disease: ESMO Clinical Practice Guidelines. Ann Oncol. 2010; 21(suppl 5):v277-v282. Full text available.
- Florescu M, Cinteza M, Vinereanu D. Chemotherapy-induced Cardiotoxicity. Maedica (Buchar). 2013 Mar; 8(1): 59–67. Full text available.
References / Further Reading
Life in the Fast LaneTextbook
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.