Irritable Heart
Report:
Sinus tachycardia 115/min
Intraventricular conduction delay QRS 0.11â
SVEBs
VEBs, frequent, bigeminal, couplet, multiform
Ventricular-ventricular bigeminy (bottom) in dimorphic ventricular tachycardia
Runs of ventricular tachycardia 220 - 280/min
Junctional escape beats
Ventricular fusion beat
Comment:
This is a situation where rash antiarrhythmic therapy may cause considerable damage. It is best to ensure normal potassium and proceed with anti-ischæmic measures, e.g., aspirin, nitroglycerin infusion and IV β-blocker.
The QR VEBs indicate that the patient may already have sustained an anterior infarction; the elevated ST segment in both the VEBs and sinus beats does nothing to reassure one to the contrary. Rhythm strips, however, may be quite misleading. A 12-Lead ECG and timely thrombolysis or PTCA should therefore be considered strongly at this point.
75. 68 year old lady with ischæmic heart disease and impaired LV function (EF 31%). The rhythm shown below was 140/min before the current procainamide infusion. What was the infusion started for?
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