Conclusion: Rate Related VS Primary ST-T Changes

  This is the conclusion to our previous case, “RATE RELATED VS PRIMARY ST-T CHANGES“. Check it out before you read the final portion.   This was the initial 12 lead ECG obtained by EMS prior ED arrival: There is an irregularly irregular tachycardia with no signs of P waves, which the Lifepak 15 determined to be Atrial Fibrillation with Rapid Ventricular Response (RVR), however, V1 also appears to have the presence of Flutter waves, so the possibility of A-flutter is present. There is evidence of subendocardial ischemia, seen as generalized ST segment depression and slight ST segment elevation in aVR. There are also signs of Left Ventricular Hypertrophy (LVH). There is normal frontal axis with good R wave proggression. Remember there are multiple things that can cause an irregularly irregular rhythm, not just A-Fib, such as: Wandering Atrial Pacemaker Multifocal Atrial Tachycardia A-Flutter with variant conduction Premature impulses Although this patient presented with Chest Pain and considered unstable by “ACLS guidelines”, no other changes where noted by field personnel, and Syncronized Cardioversion was not performed. This patient was placed on O2 at 15 Lpm via Non-rebreather mask, peripheral IV access obtained and given 324mg ASA. This was the first 12 lead ECG obtained in the ED: The ST segment depression is evolving in both precordial leads (V3-6) and frontal plane (limb leads), however the rhythm remains irregularly irregular. &nbs...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: 12 lead ecg Arrhythmias Digoxin Source Type: research