Welcome to this installment of rhythm nation, entitled Shakedown Street.
Please offer a comprehensive assessment of the following squiggles. Case details pending.
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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jfreedman
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NSR
So for realz, here’s a shot.
The basics
1) Assume its the right patient, right date and time of study
2) Assume its a standard 12 lead anterior ECG
3) Rate is > 150, read as 179 by machine, probably correct
4) Rhythm is well…not sinus, more to come
5) QRS is wide complex
6) Axis – Negative in AVR and positive in lead I has a normal axis
In my mind, the main diagnostic questions is VTach vs. SVT w/ abberrancy. The reason this is a dillema is that SVT will do well with adenosine or dilt, VTach will probably go into hemodynamic collapse – if they’re not already in it.
Fortunately, there’s a great “life in the fastlane” post on this (http://lifeinthefastlane.com/ecg-library/basics/vt_vs_svt/)
From what I learned in this post, I’m thinking this is SVT w/ aberrancy.
Some of the clues
1) Axis is normal
2) No AV disassociation
3) No capture beats
4) No RSR’ w/ high left bunny ear
5) Vectors in V1-V6 are not all the same, you have some negative some positive
6) No RSR’ with higher left bunny ear.
So push some Adenosine and say a hail mary.
afib. WPW. The guy who gave adenosine just killed the patient.
Ha, Bogoch. If “that guy” is ready to defibrillate as he should be before giving the adenosine, and then defibrillates prn, the patient will be saved!
Procainamide!