Over at Janus General, where I’m on staff, there is a …
60 yo M with SOB:
What is this rhythm and how do you treat it?
Best and most complete answer by 9/19/14 at noon will win!
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eabram
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1 Comment
jfreedman · September 18, 2014 at 6:34 pm
tough one.
here’s a stab. there are two distinct wide complex patterns in this 12 lead. the one at the end of the strip is a ventricular-paced rhythm at ~100bpm. it only occurs for a few beats at a time.
The other is crazy wide, >300msec in duration, irregular and fast ~150bpm, with varying morphology. the irregularity, varying complexes and super-width make monomorphic v tach unlikely. Polymorphic v tach could be irregular, but this doesnt have that look.
Wide complex with irregularity supports supraventricular origin, likely atrial fibrillation with abberancy. The incredible width makes me think of an electrolyte or toxicologic cause. i think the very-wide, irregular and fast complexes are outpacing the pacer.
theyre bizarre. and bizarre equals hyperkalemia first. then sodium-channel blockade?
give calcium, then bicarb. hold on tight?