This is a tough one and congratulations to the thorough responders. This month’s winner – Dr. Nico Grundmann! To start, TCA ingestion is the most common cause of Na-channel toxicity that we see in ECGs – but this patient was not taking TCA’s. She ingested more than 4 grams of Read more…
47 year-old female with past medical history of depression and supraventricular tachycardia, brought in by EMS with altered mental status and found with empty pill bottles nearby. What is the interpretation of this ECG? What likely happened to this patient? How do you treat it? Best answer Read more…
Excellent answer by Dr. Kylie Birnbaum! This patient indeed has a supraventricular tachycardia (SVT), and indeed was found to have fast-slow atrioventricular nodal re-entrant tachycardia (AVNRT) on later electrophysiologic study. In the ED at Janus General, however, vagal maneuvers failed and 6mg of Adenosine was ordered. Just prior to administration Read more…
80 yo F presents with intermittent palpitations associated with shortness of breath but is otherwise stable. What is your differential for this rhythm? How do you treat it? Best answer by Friday will win!
From the hand of Dr. Yonatan Yohannes… . This case puts the providers in a bit of a dilemma. The ECG is concerning for possible left main coronary artery (LMCA) or proximal left anterior descending (LAD) artery occlusion. However, the history and physical exam appears to be a classic presentation for Read more…
Rhythm Nation August 2014 Answer! Best and most thorough and most correct reading goes to… Dr. Freedman! The major clue to this case is the recent or evolving STEMI. In the era of thrombolysis for STEMI, the Accelerated Idioventricular Rhythm (AIVR) or Accelerated Ventricular Rhythm was often seen after reperfusion. Read more…
70 yo M with pmh DM and HTN presents with chest pain and a troponin of 41. STEMI code activated and patient taken to cath lab. Here is his EKG upon arrival: 1. What is this rhythm? 2. What is the treatment for this rhythm? Answers were due 8/15/2014… now you Read more…
Congratulations to our winner with the most complete answer: Dan Zeccola! Julie and Nathan both correctly identified parts of the answer. Well done all! Our patient was having a Spontaneous Coronary Artery Dissection (SCAD) in her mid-LAD. To answer the questions: The EKG was concerning for Wellens’ Sign and in Read more…
Answer and ECG submitted by Dr. Eli Brown. Thanks Richie/Shin. Good work in spotting the “widow maker. “ I would like to point out that this patient actually has poor R-wave progression. That, along with the QS complexes (III, aVF, V4), should raise suspicion for a subacute to chronic Read more…
Here’s another EKG to get you guys talking. Thank you Dr. Silverberg and Dr. Brown for the case. 73 chinese female h/o dm, htn and high cholesterol had syncopal episode. Felt heart racing and palpitations prior to passing out at bingo in her church. Only complaint now is slight chest Read more…