Sudden Death During Holter Monitoring
Aortic Stenosis
Report:
Top:
Sinus tachycardia 112/min
VEBs, frequent, multiform, some in couplets
Second strip:
Sinus arrhythmia 100 - 64/min
Marked ST segment depression consistent with ischæmia
Third strip:
Sinus arrest
Junctional escape rhythm 22/min
VEB
Blocked sinus (?atrial)P wave
Bottom:
Junctional ? idioventricular rhythm 32/min
Agonal ST segment elevation
Comment:
Note how the “warning arrhythmias” of the top strip failed to predict brady-asystole that followed. It may well be that complex ventricular ectopic activity is a marker of myocardial/coronary disease rather than - or as much as - a specific predictor of sudden death in VF.178
This patient almost certainly had a sudden hæmodynamic collapse, typical of aortic stenosis179, as the proximate cause of death. The GI bleeding did not help; he may have had Heyde’s syndrome180.
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