21
Feb
2017

EKG of the Month

Write in your best answers below — this month the prize is a 10$ Starbucks Gift Card!

4 Responses

  1. Nagarjuna Reddy Gujjula

    EKG:
    1. Rate > 250-300 bpm
    2. Rhythm: Irregular , no p waves followed by QRS is seen
    3. QRS: wide QRS complexes, polymorphic in nature, irregular R-R , bouncing around the baseline consistent with possible polymorphic ventricular tachycardia or TDP ( best seen in V1 and V2) given such high HR and symptoms of chest pain and dizziness
    4. Cannot appreciate ST segments, T waves, QT intervals or PR intervals.

    Another possibility is motion artifact, which can be considered if patient does not have chest pain or dizziness. Sometimes Tremors can produce this kind of artifact too.

    Given patent’s age, chest pain with dizziness with such high heart rates, this need to be considered as an emergency and patient will need ACLS support at bedside and IV magnesium to terminate TDP.

    Once rythm is terminated, need to find the underlying causes such as QT prolongation secondary to electrolyte disturbances or medication induced, ischemia need to ruled out too.

  2. Luay Sarsam

    Polymorphic VT- torsades de pointes. Risk factors includes hypokalemia, hypomagnesemia, medications that prolongs QT interval, underlying heart disease, recent conversion from atrial fibrillation, female sex.

    Other differentials for this EKG would be Tremor-induced EKG artifacts mimicking Torsades de pointes.

  3. Dr. Smer

    Great input everyone, I think you all got the correct diagnosis. Polymorphic VT, TDP.

    Roy, astute observation, this patient came in with acute inferior STEMI and while waiting at ED to be taken to cath lab, he had torsade and got shocked x3. The patient received 1st defibrillation shock while recording this ECG strip, you can see the crossing line in the middle of ECG strip…! Obviously, was unsuccessful as the arrhythmia continued and he received another 2 shocks and went back to sinus.

So, what do you think?

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