Unread Pre-Discharge ECG

Report:

Sinus rhythm 58/min

Left axis deviation - 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 previous LBBB conduction. She was readmitted with multiform VT, probably a torsade de pointes, requiring a countershock (Fig 184a below).

A timely look at the pre-discharge ECG could have saved her some trouble. Sotalol is the likely culprit for the QT prolongation and the arrhythmia. The subject has been repeatedly reviewed134.

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