A paramedic crew responded to the office of a local physician. A 61-year-old male presented with a one-week history of chest pain and shortness of breath.
Torsades de Pointes
Torsades de pointes, or polymorphic ventricular tachycardia, is a ventricular tachycardia precipitated by and associated with long QT Syndrome. Long QT Syndrome can be congenital or acquired. Torsades is life-threatening, and can be made worse by many drugs, including some of the drugs used to treat VT. The rate is usually 150 - 250 / min. and the appearance is of a wide-complex tachycardia with QRS morphology changes.
This ECG is from a 70 year old woman for which we have, unfortunately, no clinical information. It shows a sinus rhythm with a rate of about 72 bpm (NSR) with AV dissociation caused by third-degree heart block. The escape rhythm is junctional at a rate of 38 bpm. There appears to be a right bundle branch block, based on the QRS duration of 132 ms, and a wide S wave in Leads I and V6. The precordial leads do not show the usual RBBB pattern of rSR' in V1 and V2, and the r wave progression is poor (non-existent). This is felt to be due to poor lead placement (a go
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