EM Alliance ECG – Case 12

80yof vomiting, AF Hx, on verapamil (nil recent dose change).

HR 18, BP 60/P on initial presentation.

Current ECG is…

ECG courtesy of  http://www.emalliance.org/

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One Comment Add yours

  1. Tatsu Kuwasaki says:

    This is the direct translation of the Japanese Dr’s analysis guide;

    Systematic analysis;
    1. Rate: 45 bpm
    2. Rhythm: No obvious P waves. Slight widening of QRS (QTc 470ms)
    3. Axis:Right Axis Deviation
    4. Hypertrophy: RAD and R wave in V1 idicate RVH?, although low voltage does not make sense…
    5. Ischemia:NAD (Nil previous ECG available
    ECG interpretation include slow AF or Junctional Rhythm. Slight irregularity indicates slow AF more likely.

    When treating bradycardia, the first thing to think about is to decide if it is stable or unstable.
    * St John classifies unstable as “severely compromised”.

    Then think three causes of bradycardia.
    1. ACS
    2. Toxin: CCB, BB, Digoxin, Opioid, Cholinergics etc
    3. Electrolyte abnormalities: particularly hyper K

    Indeed, this Pt was hyperkalaemic 7.9!
    Peaked T waves, prolonged PRI, wide QRS, sine waves etc is well known, hyper K can also cause bradycardia.

    *Dr Mattu calls hyper K = Syphilis of ECG (lol), as it can present in many different ways.

    Like

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