Discussion for 90 year old male CC: Chest pain– Revisited

We are revisiting the Discussion for 90 year old male CC: Chest pain.  You may wish to review the case.

You may recall we pointed out that the VT appeared be regularly irregular, with alternating cycle lengths:

What follows is a "Guest Post" by Jason Roediger, CCT/CRAT, and Ken Grauer, M.D. (www.kg-ekgpress.com):

"The rhythm represents VT for all of the morphologic reasons discussed in your explanation. The reason for the repetitive regular irregularity of this ventricular rhythm is that the tracing represents VT with retrograde 3:2 Wenckebach Exit block out of the ventricular focus. The discharge rate of the ectopic ventricular focus is ~240/minute.

This results in a manifest ventricular rate that is about 2/3 the presumed discharge rate and reduces the manifest rate to ~160/minute. Note the characteristic Wenckebach periodicity conducting retrograde (with a 3:2 ratio) out of the ventricular focus in the laddergram below. FINAL point: in addition to the bizarre marked axis deviation, the entirely negative QRS in V6 with delayed nadir and other morphologic clues you state in support of the diagnosis of VT-WPW can be ruled out by the negative QS complexes in V4-V6 (Brugada)."

 

Many thanks to Jason and Ken for their insightful analysis. We are always learning!

 

 

 

 

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
Vince DiGiulio
Transcutaneous Pacing Success!!! Part 2
Thanks! I've yet to have a chance to check heart tones during TCP but I'll try to make it a priority next time to see how well it works for me.
2015-03-30 04:37:42
Snapshot Case: 85yo M – Chest Pain | EMS 12 Lead
Conclusion to Snapshot Case: 85yo M – Chest Pain
[…] UPDATE: Conclusion to this case. […]
2015-03-29 19:54:59
Jake
47 year old male CC: Crushing chest pain
I know this is old, but it just popped up on facebook so I'll go ahead and put in my $0.02 worth. With that hx and that 12-lead, there's no question this is an acute STEMI. I'm comfortable calling that third strip Torsades (assuming I've verified it's not an equipment issue). The defib pads are…
2015-03-24 14:14:19
Ngan Thanh
17 year old male CC: Syncope
I thinks about WPWs on ECG!
2015-03-21 23:27:41
bob
Adenosine for sinus tachycardia: Try to avoid this!
I have a better answer for Shay's patient (and Mel) and it's called lone a-flutter because I just had it diagnosed in me. I'm looking at my ekg showing a rate of 230 which fooled the doc who thought it was svt's until I told him I had no history of anything and talked him…
2015-03-21 21:57:17

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