ECG Case 059
57-year old man with ROSC following VF arrest. Interpret the ECG.
Describe and interpret this ECG
ECG ANSWER and INTERPRETATION
Main Abnormalities
- Sinus rhythm with frequent ventricular ectopics in a pattern of ventricular bigeminy.
- Grossly prolonged QT interval (> 600 ms).
- “R on T” phenomenon is present, with each VEB falling on the end of the T wave — this ECG pattern is very high risk for deterioration to torsades de pointes and ventricular fibrillation.
- Relatively short PR interval and possible delta waves (leads I, II, V6) are suggestive — but not diagnostic — of WPW syndrome.
- Voltage criteria for left ventricular hypertrophy are present in multiple leads.
This patient had suffered a cardiac arrest in the context of severe hypertrophic cardiomyopathy and long QT syndrome.
(NB. ~1/3 of patients with HOCM will have some evidence of WPW on their ECG).
Can you guess what happened next?
The patient had a further TdP cardiac arrest!
This was treated with IV magnesium and potassium, with restoration of sinus rhythm.
This interesting case is discussed in Cardiovascular Curveball 003
TOP 100 ECG Series
Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |