Myocarditis: the Cascade Effect
Report:
Sinus tachycardia 122/min
First degree AV block
PR interval 0.22”
Left anterior hemiblock
Right bundle branch block
ST/T changes c/c anteroseptal infarction or myocarditis
Comment:
Sinus P waves are best seen at the end of the T wave in the inferior leads; their PR interval is certainly prolonged, both for the heart rate and the patient’s age.
The interesting feature here is the elevated ST segment in V1-2: it rapidly dips into the inverted T wave – the cascade effect of Schamroth’s43. This is highly characteristic, he says, of acute carditis. Her ejection fraction was 25% on admission. This is similar to Case 240, but with a happy ending: she developed complete heart block, was paced, and survived with good recovery.
Below (Fig 40a) is a tracing taken a day earlier, showing sinus tachycardia with tendency to Wenchebach and runs of (probably reentry) SVEBs and SVT.
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