Isoprenaline in Myocarditis

Report:

Sinus tachycardia 102/min

(Probable) incomplete RBBB

Left anterior hemiblock

Marked ST segment elevation

Cascade effect

Comment:

In septal leads there is a gross elevation of the ST segment, which merges into an inverted T wave. This is the cascade effect typical of myocarditis171. Similar appearances are seen in Case 40. Like there, the intraventricular conduction defects evolved into 3o AVB, but this patient had isoprenaline instead of pacing (on telephone advice from her Cardiologist), with VT and VF, and died. Some of her rhythm strips are shown overpage (Figs 240a, 240b).

I was called to ICU to find she had been transferred there form CCU, undergoing CPR for refractory asystole that followed VT and VF. Junior staff did that in the hope I could still pace her, having recently introduced bedside transvenous pacing in the ACT. It was very moving, but I could not even try: she had been dead for too long.

Isoprenaline is not only arrhythmogenic, but can also, through peripheral vasodilatation, preclude successful resuscitation. Both effects were apparent in this unfortunate patient172.

240a. Dissociated junctional rhythm and two VEBs in the bottom strip. 240b. Isoprenaline effect in extreme sinus tachycardia.

241. Agonal strips in a 60 year old alcoholic with hepato-renal syndrome

Continued from above.