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What are treatment options for this rhythm, when all else fails?

Dr. Smith's ECG Blog

He required multiple defibrillations within a period of a few hours. This time, the arrhythmia did not spontaneously terminate — but rather degenerated to VFib, requiring defibrillation. In both tracings — an exceedingly fast PMVT is documented. Below are printouts of some of the arrhythmias recorded. What do you think?

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EM@3AM: Brugada Syndrome

EMDocs

Brugada sign refers to the findings on ECG, while Brugada syndrome is the combination of ECG findings with one of the following: documented ventricular tachycardia or fibrillation, syncope, family history of sudden cardiac death at < 45 years old, or inducible ventricular tachycardia with programmed electrical stimulation. Circulation.

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ECG Pointers: Recurrent and Refractory Torsades de Pointes

EMDocs

Defibrillator pads are placed and you give 2 g IV magnesium over ten minutes. Figure 3/ Adapted from Wilde et al. A complete approach to treating cLQTS can be found in Wilde et al 2. It is recommended to use an unsynchronized setting as the defibrillator may not be able to track the R-wave in the polymorphic waveform.

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Seizure in a 30 something

Dr. Smith's ECG Blog

This episode self terminated before defibrillation was possible. See Costagliola et al — Ann Clin Transl Neurol 8(7): 1557-1568, 2021 — for more on the complex "Brain-Heart Interaction" in Epilepsy ). This run of TdP is initiated by a PVC — but it then self-terminates. Discussion : The patient in today’s case presented with "seizures".

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Cardiac Rhythms/ECG Module

Don't Forget the Bubbles

Stredder et al, Archives of Disease in Childhood 2016 we see that 58% were not asked about triggers, 30% were not asked about duration and, importantly for risk stratification, 59% were not asked for a family history of cardiac disease. Where there are a number of unexplained deaths, start to be more critical about what this could mean.

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Hyperthermia and ST Elevation

Dr. Smith's ECG Blog

Our patient had a Brugada Type 1 pattern elicited by an elevated core temperature, which is also a documented phenomenon. In the largest study looking at this topic by Mizusawa et al., Recently the rate of true arrhythmic events related to fevers in the classic Brugada Type 1 syndrome was explored by Michowitz et al.

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Case Report: Cardiac Arrest in a Child’s Structurally Normal Heart

ACEP Now

He was defibrillated twice and received two doses of epinephrine, with return of spontaneous circulation. A repeat ECG (see figure 3) was performed utilizing the technique described by Sangwatanaroj et al., He underwent placement of a dual chamber, implantable, cardioverter-defibrillator (ICD) placement on hospital day 5.

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