Shifting Rabbit Ears in VT
Report:
Ventricular tachycardia 152/min
Possible old anterior infarction
Comment:
There is a monophasic R, possibly a qR, in V1, with northwest axis in the standard leads and QSs in V5-6. The patient in fact had an old anterior MI (Fig 106a below, in AF, with LAHB + IVCD).
The rabbit ears in V1 are interesting: they seem to vary from beat to beat, presumably with respiration. The computer-stored (digitalised) ECGs are not ideal for finer details of morphology, tending to look as though composed of Lego bricks (which they are, magnified on a screen). One cannot fight âprogressâ, anyway. Very small rabbit ears are of course more likely to shift their disposition.
The implanted cardioverter-defibrillator failed to perform because its detection rate was set at 190/min; resetting the rate fixed the problem of recurrent VT for a short time, but then the patient had to return for EPS with more VT. Amiodarone and metoprolol failed, but sotalol appeared successful.
106a.
107. Milrinone, 50 μg/Kg/min, increased the cardiac index from 2.0 to 2.6 L/min/M2 in this 69 year old man dying in cardiogenic shock from a large basal infarction.
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