Case 165: A 65 Year-Old Woman Presents to ER with Syncope
History
Diagnosis
ECG 2
ECG 2 Diagnosis
History
A 61 year-old woman presents to the ER with syncope. She is brought to ER via EMS and is awake but hypotensive and tachycardic. She has a background history of hypertension, active smoking, type 2 diabetes, dyslipidemia, obesity, and peripheral arterial disease. Her ECG at time of presentation is shown below.
Diagnosis
- Ventricular tachycardia, rate 258/min
Comment: Although there is no clear AV dissociation, this wide complex regular tachycardia has a very bizarre QRS complex which does not meet criteria for either right or left bundle aberrancy. In addition, her history of several cardiac risk factors makes it more likely that she has ischemic heart disease which increases the pre-test probability of ventricular tachycardia.
ECG 2
In the ER, the patient was cardioverted to sinus rhythm and then remained hemodynamically stable. Her echocardiogram showed inferior hypokinesis but overall preserved LV function. Her ECG after cardioversion is shown below.
ECG 2 Diagnosis
- Sinus bradycardia, rate 45/min
- Inferior myocardial infarction (Q-waves inferior leads)
Comment: The patient was taken to the cardiac catheterization laboratory after stabilization and found to have an occluded right coronary artery with both antegrade and retrograde collaterals
ECG ID: E818