Sluggish Performance of Fat Complexes

Report:

Atrial fibrillation with controlled response (top & bottom)

Mean BP 85 & 83 mmHg

Pacemaker rhythm (middle)

Mean BP 68 mmHg

Comment:

The slight asynchrony in contraction secondary to LBBB-type conduction becomes significant in a critically impaired ventricle165. Non-ischaemic chest pain may also result166.

This is not due to abolition of atrial transport by ventricular pacing: the patient is already in AF.

More of the same is illustrated below (Figs 236a, 236b). Ideally, the patient should have developed LBBB of his own; then the ventricular pacing should make no difference! A bad taste joke one says on the rounds.

236a.

236b. 237. Lifepak monitor strip taken during unsuccessful resuscitation of a 71 year old man with acute inferior infarction and sudden onset of electromechanical dissociation (EMD). What could be the significance of the tall T waves recorded?

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