Which of following coronary arteries is most likely involved in this patient?
Anonymous Poll
54%
Left anterior descending artery (LAD)
11%
Left circumflex artery (LCX)
17%
Right coronary artery (RCA)
17%
Left main coronary artery (LMCA)
The ECG shows upslope ST-Depressions and peaked T waves in the anterior leads. this pattern is called “De Winter T wave” and seen in ~2% of acute LAD occlusions.
What is the most likely diagnosis?
Anonymous Poll
52%
Acute myocardial infarction complicated by Ventricular tachycardia
7%
Sinus tachycardia and massive myocardial infarction
17%
Atrial fibrillation with LBBB
23%
Hyperkalemia
The correct answer is “Acute myocardial infarction complicated by Ventricular tachycardia”
• The ECG shows a wide complex tachycardia at a rate of ~175 bpm. Although the rhythm is irregular, there are findings that suggest ventricular tachycardia (VT); Most notably AV dissociation (P waves are shown with arrows). As you see, there is no relationship between P waves and QRS complexes. Note that VT may be irregular in particular at the beginning.
• STT changes are common findings in any rhythm with wide QRS complexes including VT, However, despite secondary STT changes, there are concordant ST-elevations (ST-elevations in leads with positive QRS complexes) in leads 1, aVL and V6 which suggest acute myocardial infarction (MI). The next ECG is taken after the patient got cardioversion shock and confirms anterolateral MI.
• STT changes are common findings in any rhythm with wide QRS complexes including VT, However, despite secondary STT changes, there are concordant ST-elevations (ST-elevations in leads with positive QRS complexes) in leads 1, aVL and V6 which suggest acute myocardial infarction (MI). The next ECG is taken after the patient got cardioversion shock and confirms anterolateral MI.
43-year-old female with history of unknown heart surgery in the childhood presented with sudden onset palpitation and confusion. Due to hemodynamic instability, cardioversion shock was performed and successfully restored its sinus rhythm, which is shown in the next slide.
What was the patient’s initial rhythm?
Anonymous Poll
28%
Ventricular tachycardia
72%
Supra-ventricular tachycardia with RBBB
Regular wide complex tachycardias can be either ventricular (VT) or supraventricular (SVT with aberrancy) in origin, and differentiation between the two is usually challenging.
Since QRS morphologies in the sinus rhythm are the same as in the broad complex tachycardia, an SVT with aberrancy is more likely than VT.
Since QRS morphologies in the sinus rhythm are the same as in the broad complex tachycardia, an SVT with aberrancy is more likely than VT.
Which of following best explains the patient’s presentation?
Anonymous Poll
28%
AV node ischemia
35%
Sick sinus syndrome
6%
Structural heart disease
31%
Electrolyte abnormalities