The Frailty of Lead 2 Monitoring

Report:

Sinus rhythm 78/min

VEBs in bigeminy

Right bundle branch block

Small voltage

Possible old anterior infarction

Comment:

Leads V1-5 clearly distinguish between the ectopic ventricular and the sinus RBBB conduction. Lead 2 performs, as usual, badly: the ectopic and the supraventricular complexes are almost identical. This bigeminy was not recognised in Casualty; if it was, some of the re-runs of VT could have been prevented.

The VEBs are of late-diastolic variety, and a “tad of fusion” cannot be excluded.

Below (Fig 124a) is one of the numerous runs of VT that led to the patient’s admission to ICU. Again, the lead 2 strip gives little indication of the ventricular ectopic provenance of the tachycardia.

The patient did very well on the (now obsolescent) xylocaine infusion and the (recently introduced) hypothermia111 treatment. A later ECG suggested hypothyroidism (Fig 124b) – a false lead.

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