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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