1/15. Wide QRS complex tachycardia: ECG differential diagnosis.Wide QRS complex tachycardias (WCT) present significant diagnostic and therapeutic challenges to the emergency physician. WCT may represent a supraventricular tachycardia with aberrant ventricular conduction; alternatively, such a rhythm presentation may be caused by ventricular tachycardia. Other clinical syndromes may also demonstrate WCT, such as tricyclic antidepressant toxicity and hyperkalemia. Patient age and history may assist in rhythm diagnosis, especially when coupled with electrocardiographic (ECG) evidence. Numerous ECG features have been suggested as potential clues to origin of the WCT, including ventricular rate, frontal axis, QRS complex width, and QRS morphology, as well as the presence of other characteristics such as atrioventricular dissociation and fusion/capture beats. Differentiation between ventricular tachycardia and supraventricular tachycardia with aberrant conduction frequently is difficult despite this clinical and electrocardiographic information, particularly in the early stages of evaluation with an unstable patient. When the rhythm diagnosis is in question, resuscitative therapy should be directed toward ventricular tachycardia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/15. Ventricular tachycardia in an adolescent with arrhythmogenic right ventricular dysplasia.We report the case of an adolescent boy with exertional syncope and ventricular tachycardia caused by arrhythmogenic right ventricular dysplasia. diagnosis was determined by transthoracic echocardiography and definitive management with an automatic internal cardiac defibrillator. Emergency physicians must be aware of this serious but treatable cause of adolescent exertional syncope.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/15. Artifactual electrocardiographic change mimicking clinical abnormality on the ECG.Electrocardiographic artifact is a common finding in patients requiring evaluation and monitoring in the prehospital, emergency department, or intensive care unit settings. Artifact results from both internal (physiological) and external (nonphysiological) sources. In most instances, artifact is recognized as an incorrect electrocardiographic signal--its only impact producing interference in electrocardiogram interpretation; artifact may also produce electrocardiographic signals which mimick disease--these signals the physician must recognize as artifact.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/15. brugada syndrome as the cause of syncope in a 49-year-old man.We report the case of a 49-year-old man in whom a diagnosis of brugada syndrome was made after he presented to the emergency department for evaluation of a syncopal episode. The diagnosis was made by ECG changes, after the characteristic findings of peculiar downsloping ST-segment elevation in leads V(1) and V(2) and QRS morphology resembling a right bundle branch block were identified. Emergency physician recognition of this syndrome and its ECG findings is essential, because without treatment the incidence of sudden cardiac death in these patients is high.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/15. brugada syndrome: an unusual cause of convulsive syncope.A patient who presented with a new apparent seizure was found to have abnormal electrocardiographic findings, with classic features of the brugada syndrome. He had spontaneous episodes of nonsustained ventricular tachycardia, easily inducible ventricular fibrillation at electrophysiological study in the absence of structural heart disease, and a negative neurological evaluation. These findings suggested that sustained ventricular arrhythmias known to be associated with the brugada syndrome and resultant cerebral hypoperfusion, rather than a primary seizure disorder, were responsible for the event. patients with the brugada syndrome often present with sudden death or with syncope resulting from ventricular arrhythmias. In consideration of its variability in presentation sometimes mimicking other disorders, primary care physicians and internists should be aware of its often transient electrocardiographic features.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/15. The brugada syndrome.brugada syndrome describes the syndrome of sudden cardiac death in the setting of the following electrocardiographic findings: right bundle branch block pattern with ST-segment elevation in the right precordial leads. The right bundle branch block may be incomplete while the ST segment elevation is minimal. The electrocardiographic findings are not constant. patients suspected of having brugada syndrome should be promptly referred for electrophysiological testing and treatment. Rapid referral and placement of an implantable cardioverter defibrillator (ICD) is associated with an excellent prognosis, whereas failure to diagnose this condition is associated with a high risk for sudden death. Therefore, it is imperative that all emergency physicians be familiar with the typical ECG manifestations of brugada syndrome. Three illustrative cases are presented with a review of the syndrome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/15. Ventricular tachycardia following naloxone administration in an illicit drug misuse.A case of ventricular tachycardia in a 37-year-old man after ingestion of heroin and cocaine, treated with naloxone is described. The arrhythmia is attributed to unopposed sympathomemetic effects of cocaine following administration of naloxone. The pro-rhythmogenic effects of naloxone may have contributed to the arrhythmia. He was initially treated sequentially with intravenous magnesium sulphate, calcium gluconate, sodium bicarbonate and lignocaine infusion, with no resolution of the ventricular tachycardia. He was admitted to the coronary care unit and was given an amiodarone infusion which converted the rhythm to sinus rhythm. Forensic physicians administering naloxone to poly-drug abuser in a custodial setting should be aware of potentially fatal consequences which they will be unable to detect. It is recommended that all such patients should be transferred to hospital for observation and investigation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/15. Anesthetic management of a patient with asymptomatic ventricular tachycardia.There are many causes of ventricular arrhythmias in pediatric patients, even those with structurally normal hearts. However, in young patients with 'normal' hearts, sustained ventricular arrhythmias are relatively rare. The primary concern of the physician is to identify which patients have benign ventricular arrhythmia patterns and which are at risk for sudden cardiac death. Even in asymptomatic patients, the choice of anesthetic agents may be important to minimize precipitation of episodes of tachyarrhythmias. This clinical report describes the anesthetic considerations for an asymptomatic child with a history of sustained premature ventricular contractions, ventricular tachycardia, and bigeminy. This child had chronic serous otitis media requiring repeat tympanostomy and tube replacement. This case report outlines the initial cancellation of anesthesia because of sustained arrhythmias, and subsequent conduct of the anesthesia for the case, as well as the considerations in the selection of the drugs when a child presents with significant ventricular arrhythmia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/15. Bilateral upper extremity thrombophlebitis related to intravenous amiodarone: a case report.A 47-year-old male had bilateral upper extremity thrombophlebitis after use of intravenous amiodarone for sustained ventricular tachycardia complicating myocardial infarction. Intravenous amiodarone has been widely used since it was introduced 20 years ago for severe intractable arrhythmias. Superficial thrombophlebitis was frequently noted in the early case reports when high-dose intravenous amiodarone was used. Superficial thrombophlebitis could extend hospitalization and become a significant source of distress to our patients. Some authors recommend insertion of a central line to administer intravenous amiodarone especially with expected extended use of therapy. The treating physician should be vigilant and switch from intravenous therapy to oral therapy as soon as the patient's condition stabilizes and oral therapy can be started.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/15. Pacemaker tachycardia in a minute ventilation rate-adaptive pacemaker induced by electrocardiographic monitoring.Programmed upper rate pacing occurred in a patient with a rate-adaptive pacemaker when he was connected to a cardiac monitor in an emergency department. The tachycardia was mistakenly interpreted to be ventricular tachycardia and the patient received multiple DC shocks as well as intravenous amiodarone and sotalol, resulting in severe hemodynamic deterioration. It is important that physicians working in the hospital environment be familiar with this pacemaker-monitor interaction as the problem may be easily rectified by disconnecting the monitor or by reprogramming the pacemaker to a nonrate-adaptive pacing mode.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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