Agonal Rhythm

Report:

Atrial standstill

VEBs (ventricular escape beats)

Ventricular tachycardia 110/min

Comment:

Despite its irregular rate, the broad complex tachycardia is unlikely to represent ventricular response to atrial fibrillation. The agonal rhythm is usually asystole at the time when the monitor is turned off, but sometimes there is a surprising burst of tachycardia. If the family is watching, it is often wise to turn the monitor off, once electromechanical dissociation (EMD) is confirmed.

It is interesting how our psychology allows for effortless diagnosis of a single VEB but puts considerable obstacles to confirming a morphologically identical VT. Schamroth, somewhere, made that point many years ago. A pedant, he said, could never diagnose ventricular tachycardia!

239. 59 year old lady, cardioverted from AF after a week on digoxin and amiodarone therapy

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