A Cook County Hospital Emergency Medicine Blog for up-to-date medicine and more.
Figure 1. Index visit ecg.
The Case:
A 72-year-old woman presents with chest pain. Her ECG is abnormal in a few ST segements, but not because of your typical ST segment elevation. Here we relay a discussion of a particular channelopathy important to consider for the emergency physician.
Vladimir Bernstein, MD
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Figure 1. Adapted from Dr. Smith's EKG Blog. Source: http://hqmeded-ecg.blogspot.com/2013/10/polymorphic-ventricular-tachycardia.html
The Case:
A 40-year-old female presents to the emergency department for palpitations and lightheadedness. She has a history of depression on citalopram, migraines on amitriptyline, and was recently prescribed tramadol after she broke her wrist. She is well-appearing, and while being placed on the monitor, she becomes anxious, stating the symptoms are recurring. An ECG is performed, with Figure 1 serving as a representative EKG. The patient is awake and talking. Defibrillator pads are placed and 2 g IV magnesium is administered twice each over ten minutes resulting in the termination of the prior rhythm. A repeat EKG is obtained and is similar to that in Figure 2. The patient remains stable, but then degenerates again into an aberrant rhythm. What do you do next?
Adam Roussas, MD and Robert Feldman, MD
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Figure 1. Index ECG notable for sinus tachycardia with inferolateral borderline ST-segment depressions.
The Case:
A 47-year-old M with a PMHx of unspecified substance use was transferred from blue team to red team for progressive altered mental status, fever, and episodes of severe bradycardia with confusion (ECG from Cook County). Figure 1 was obtained when the patient initially arrived to red team, and 40 minutes later Figure 2 was obtained, with the patient having intermittent tachycardia and bradycardia in between.
Jose Reyes, MD
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