Unread Pre-Discharge ECG
Report:
Sinus rhythm 58/min
Left axis deviation (LAD) - 50o
Intraventricular conduction defect (IVCD)
Probably LAHB + non-specific conduction delay
Possible LVH
Giant anteroseptal T wave inversion
Prolonged QT interval 0.660”
(QTc for 58/min 0.45”)
Comment:
The T wave inversion may have been caused by syncope, perhaps mediated by an arrhythmia or GI bleeding, or previous LBBB conduction. There is no record of syncope in her chart. She was readmitted with multiform VT, probably a torsade de pointes, requiring a countershock (Fig 91a).
A look at the pre-discharge ECG could have saved her some trouble. The only report was that provided by the computer: “Normal sinus rhythm. Intraventricular conduction delay ? atypical LBBB.” Sotalol is the likely culprit for the QT prolongation and the arrhythmia. The subject has been reviewed extensively86.
The pre-sotalol cardiogram is shown in Fig 91b.
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