Isoprenaline in Myocarditis
Report:
Sinus tachycardia 102/min
(Probable) incomplete RBBB
Left anterior hemiblock
Marked ST segment elevation
Cascade effect
Comment:
In septal leads there is a gross elevation of the ST segment, which merges into an inverted T wave. This is the cascade effect typical of myocarditis171. Similar appearances are seen in Case 40. Like there, the intraventricular conduction defects evolved into 3o AVB, but this patient had isoprenaline instead of pacing (on telephone advice from her Cardiologist), with VT and VF, and died. Some of her rhythm strips are shown overpage (Figs 240a, 240b).
I was called to ICU to find she had been transferred there form CCU, undergoing CPR for refractory asystole that followed VT and VF. Junior staff did that in the hope I could still pace her, having recently introduced bedside transvenous pacing in the ACT. It was very moving, but I could not even try: she had been dead for too long.
Isoprenaline is not only arrhythmogenic, but can also, through peripheral vasodilatation, preclude successful resuscitation. Both effects were apparent in this unfortunate patient172.
Agonal Hyperkalæmia
Report:
Top two strips:
Atrial fibrillation with rapid response.Ventricular tachycardia, non-sustained
Third strip:
Ventricular tachycardia 146/min ?retrograde conduction
Fourth strip:
Sinus tachycardia 130/min
Fifth strip:
Sinus bradycardia 40/min. Peaked T waves
Sixth strip:
Sinus bradycardia 39/min. Left atrial abnormality. VEB with retrograde conduction. Peaked T waves
Seventh strip (top, second panel):
Sinus bradycardia 43/min ?junctional rhythm. Peaked T waves. Intraventricular conduction delay, QRS 0.16”
Eighth & ninth strips:
Progressive sinus bradycardia 32 - 30/min. Left atrial abnormality. Progressive first degree AV block, PR interval 0.24 - 0.34”. IVCD, VEBs
Tenth strip:
Broad-complex rhythm 40-55/min. QRS/T merged together
Bottom two strips:
Multiform ventricular tachycardia. Slow ventricular fibrillation
Comment:
The agonal progression is typical of hyperkalæmia. It is usually impossible to separate it from the effects of acidosis and hypoxæmia also present.
If you have any suggestions for or feedback on this report, please let us know.
Hi, can we chat about some terms and conditions?
The library and it's records are licensed under the Creative Commons Attribution 4.0 International license.
You are free to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
By clicking agree below, you are agreeing to adhere to CC BY 4.0.