Tombstones
Report:
Sinus tachycardia 111/min
Acute extensive anterior infarction
Comment:
The ST segment hyperelevtion (âtombstoningâ) bodes ill for the patient. This one died within 24 hours, ventilated for cardiogenic shock and resultant multi-organ failure. At a faster rate, broad-complex tachycardia can be (and only too often is) misdiagnosed.
Tombstone morphology is discussed in Case 92.
Below is another tracing, taking a few hours later (Fig 20a). The ST elevation has lessened, but the appearance is even more like real tombstones. The rate is faster. There had been no response to thrombolytic therapy with r-tPA; it was repeated (ârescue reperfusionâ), to no avail. PTCA could not be organised.
Tombstoning is associated with critical proximal LAD artery stenosis15 and reperfusion (but not in this case) polymorphous VT16.
Fig 20a. Sinus tachycardia â rarely a primary arrhythmia â implies a problem.
21. 41 year old man with chest pain.
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