What is the most likely diagnosis?
Anonymous Poll
52%
Acute myocardial infarction complicated by Ventricular tachycardia
7%
Sinus tachycardia and massive myocardial infarction
17%
Atrial fibrillation with LBBB
23%
Hyperkalemia
The correct answer is “Acute myocardial infarction complicated by Ventricular tachycardia”
• The ECG shows a wide complex tachycardia at a rate of ~175 bpm. Although the rhythm is irregular, there are findings that suggest ventricular tachycardia (VT); Most notably AV dissociation (P waves are shown with arrows). As you see, there is no relationship between P waves and QRS complexes. Note that VT may be irregular in particular at the beginning.
• STT changes are common findings in any rhythm with wide QRS complexes including VT, However, despite secondary STT changes, there are concordant ST-elevations (ST-elevations in leads with positive QRS complexes) in leads 1, aVL and V6 which suggest acute myocardial infarction (MI). The next ECG is taken after the patient got cardioversion shock and confirms anterolateral MI.
• STT changes are common findings in any rhythm with wide QRS complexes including VT, However, despite secondary STT changes, there are concordant ST-elevations (ST-elevations in leads with positive QRS complexes) in leads 1, aVL and V6 which suggest acute myocardial infarction (MI). The next ECG is taken after the patient got cardioversion shock and confirms anterolateral MI.
43-year-old female with history of unknown heart surgery in the childhood presented with sudden onset palpitation and confusion. Due to hemodynamic instability, cardioversion shock was performed and successfully restored its sinus rhythm, which is shown in the next slide.
What was the patient’s initial rhythm?
Anonymous Poll
29%
Ventricular tachycardia
71%
Supra-ventricular tachycardia with RBBB
Regular wide complex tachycardias can be either ventricular (VT) or supraventricular (SVT with aberrancy) in origin, and differentiation between the two is usually challenging.
Since QRS morphologies in the sinus rhythm are the same as in the broad complex tachycardia, an SVT with aberrancy is more likely than VT.
Since QRS morphologies in the sinus rhythm are the same as in the broad complex tachycardia, an SVT with aberrancy is more likely than VT.
Which of following best explains the patient’s presentation?
Anonymous Poll
28%
AV node ischemia
35%
Sick sinus syndrome
6%
Structural heart disease
31%
Electrolyte abnormalities
The ECG reveals an irregular bradycardic arrhythmia, characterized by conduction abnormalities at the level of both SA node, as evidenced by the absence of some P waves, and the AV node, where the P waves fail to conduct to the ventricles to produce QRS complexes.
The coexistence of mixed conduction abnormalities in the context of end-stage renal disease (ESRD) raises suspicion for electrolyte imbalances as the primary etiology. This hypothesis was substantiated by laboratory findings indicating elevated levels of potassium (6.7 mg/dL) and decreased levels of calcium (7.1 mg/dL).
The coexistence of mixed conduction abnormalities in the context of end-stage renal disease (ESRD) raises suspicion for electrolyte imbalances as the primary etiology. This hypothesis was substantiated by laboratory findings indicating elevated levels of potassium (6.7 mg/dL) and decreased levels of calcium (7.1 mg/dL).
What kind of block is observed in the ECG?
Anonymous Poll
16%
SA node block
26%
Type 1 AVB
24%
Second degree AV block: Mobitz type 1
24%
Second degree AV block: Mobitz type 2
10%
Complete heart block