-USE.png) |
| Figure-1: The initial ECG in today's case — obtained from a patient with "palpitations". (To improve visualization — I've digitized the original ECG using PMcardio). |
-labeled-USE.png) |
| Figure-2: XXXX |
-USE.png) |
| Figure-3: XXXX |
==================================
Acknowledgment: My appreciation to Mohammed Elsisi (from Benha City, Egypt) — for allowing me to use this case and this tracing.
==================================
Mohammed Elsisi <mohammedelsisi18@gmail.com> (3/11/2026)
— from Mohammed Elsisi (Benha City, Egypt) —
— "Caused by an Acute MI? "
NOTE — I wrote Mohammed via email on 6/27, asking if EP Study was done?
— Mohammed wrote back that "unfortunately there is no follow-up! "
These ecgs :Obtained from a 60 y old male patient free past history apart from a psychoatric illness & was on quitapine, valproate & riperidone
. Heavy smoker
Presents with acute onset palpitations
Ecg during episode as shown
Pt was stable but the er physician shocked him & reverted to sinus brady as shown
Echo reveals a mid range EF ~ 45 _50% with rhin hypokinetic apex proper d adjoining apical segments
Troponin serialy negative
My interpretation is :
Regular WCT ~110ms or slightly above
With lbbb morphology & rt axis
May be RVOT VT
With retrograde va conduction in a 1: 1 fashion evident in inf leads
The other ECG show sinus bradycardia with rbbb & std TWI in v1 v5
May be ischemic changes but no evolutionary changes on serial ecg
Thoughts??
In this case also pt should be referred to EPS study & possible ablation for this vt
No indication for icd here
What do you think?
MY REPLY:
Hi. I'd LOVE to use this case for an ECG Blog — if I can have your permission. Would help if you are able to get follow-up — but even if you can't, it is an excellent teaching case.
So I agree with you — I think this is RVOT VT for the reasons you state = there is a regular WCT ( Wide-ComplexTachycardia) at ~170/minute without sinus P waves. Instead (as you say) — it looks like there is 1:1 VA (retrograde) conduction in the inferior leads. QRS morphology is consistent with RVOT VT given all neg QRS complexes in the anterior leads — that then become positive by V6 — with a right axis in the limb leads.
I agree that I would refer the patient for EP testing — as this may be a rhythm that can (and should) be ablated.
I would repeat the Echo in a day or two, as the impaired LV function may be a result of being in the VT for a period of time.
As to the repeat ECG after cardioversion — the T wave inversion may be "Memory" — which is the name given to ST-T wave changes that are sometimes transiently seen after a patient has been in a sustained tachycardia for a period of time. Usually this goes away within hours or a day or two — and it is NOT indicative of coronary disease. Of course, you always have to rule out coronary disease, which it sounds like you did because there were no serial ECG changes. Were Troponins drawn to rule out an MI as the cause of the VT?
Let me know if you get follow-up (and IF I can use this case) — THANKS — :) Ken
Mohammed REPLY:
Of course can use it as teaching case in a blog
Troponin was drawn & serially negative
Patient was referred for an eps study
MY REPLY:
Thanks for your quick reply. Good that Troponin was negative! — which means that this IS most likely "Memory" — and not related to heart disease (especially if this T wave inversion goes away over the next 24-48 hours!).
Let me know what the EP Study shows!
Otherwise — I like to acknowledge people who send me tracings — so Please tell me how you would like me to write your name AND also the city and country you are from — OR — if you prefer, I can make this an "anonymous" case — Just let me know! THANKS — :)
It may be a while — but I will let you know when I do publish this! — :)
Mohammed Reply: — YES — To Acknowledge him !!!!
Mohammed elsisi
From benha city egypt
No comments:
Post a Comment