FL_Medic Posted May 26, 2009 Share Posted May 26, 2009 81 y/o female with altered mental status. Link to comment Share on other sites More sharing options...
Tom B. Posted May 26, 2009 Share Posted May 26, 2009 (edited) <s>It's the ghost rhythm. I've not seen it before</s>. I can see it now! Tom 81 y/o female with altered mental status. Edited May 26, 2009 by Tom B. Link to comment Share on other sites More sharing options...
Kiwiology Posted May 26, 2009 Share Posted May 26, 2009 Rate: 60 (both atrial and ventricular rate are the same) Regular: Yes P waves: Yes, before each QRS (no extrasystoles) PR interval: Seems normal but could almost be 0.16 seconds as the tracing is not great QRS complex: seems to be an RS complex with no ventricular extrasystoles T wave: Depressed, very depressed in V2-6 and appears nonexistant in aVL although the depression may be very small Is this a bradycardic escape rhythm perhaps? Link to comment Share on other sites More sharing options...
Jeepluv77 Posted May 26, 2009 Share Posted May 26, 2009 How come I still can't see it!? Link to comment Share on other sites More sharing options...
Kiwiology Posted May 26, 2009 Share Posted May 26, 2009 click the image and you can it opens in a new window Link to comment Share on other sites More sharing options...
fiznat Posted May 26, 2009 Share Posted May 26, 2009 (edited) copy this to your browser: http://2.bp.blogspot.com/_7zQULPNQ7FQ/Shvo...tripTease10.jpg Regular, narrow-complex rhythm with regular, monomorphic p-waves. There is left axis deviation, I'd guess at about -150 degrees. I'm going to call this a sinus rhythm (possibly sinus brady) with global T wave inversions. T wave inversion like this is indicative of cardiac ischemia, and should be treated as such. Another interesting thing I found is that a preponderance of patients presenting with these changes are female. Any idea if this was a man or a woman? Edited May 26, 2009 by fiznat Link to comment Share on other sites More sharing options...
Tom B. Posted May 26, 2009 Share Posted May 26, 2009 The altered mental status has me concerned. I would immediately inspect the head for trauma and consider this a neuro patient until proven otherwise. Neurological truama and/or intracranial pressure can create T wave abnormalities. In addition, the QT interval is considerably prolonged (QTc of about 575). This patient needs a cat scan and blood work. Tom Link to comment Share on other sites More sharing options...
fiznat Posted May 26, 2009 Share Posted May 26, 2009 In response to Tom: I did read about that. Supposedly a good number of post-ictal patients have ECGs with global T wave changes like this. Maybe our patient had a seizure? Something to think about, as well as CAD/ACS. Link to comment Share on other sites More sharing options...
FL_Medic Posted May 27, 2009 Author Share Posted May 27, 2009 If anyone is wondering about the black bands. It is the Insert: SPOILER tool. It is being used to display the answers of the posters without them accidently being seen by the unwilling. Link to comment Share on other sites More sharing options...
FL_Medic Posted May 27, 2009 Author Share Posted May 27, 2009 The answer: Highlight below, only if you want to see the answer. This was an ECG from a medscape CME activity. I thought it would be a good example of non-cardiac ECG changes. This is an ECG from a patient with frontal bilateral subdural hematomas. Good job Tom and fiznat. Link to comment Share on other sites More sharing options...
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