VEA in CVA

Report:

Sinus rhythm approx. 65/min

Frequent VEBs in couplets, single one interpolated

Left bundle branch block

QRS 0.14”

Comment:

The VEBs are narrower in many leads than the LBBB sinus beats; this is not unusual in patients with bundle branch blocks. The VEA seems to arise from the distal, unblocked, part of the left bundle branch – presumably its posterior division (hence VEBs’ LAD, while LBBB itself has normal axis).

The VEA was almost incessant over three days, but never progressed to higher things. There were a few episodes of junctional rhythm (Fig 279a), but cardiac output was never in question. Monitoring CVAs is, generally speaking, a waste of time, but ventilated patients are – and have to be – routinely monitored anyway.

This unfortunate patient chose (by blinking) to die. I told him how brave and dignified he was, and that he would be then asleep on morphine. And that I would make the same choice. It went well.

This kind of demise does not proceed as well nowadays; the less said the better.

279a.

280. 40 year old lady with severe epigastric pain