CMC COMPENDIUM
  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction

Is This Ischemia?

6/8/2015

0 Comments

 
HPI:  Approximately 30 year old female with history of frequent PVCs presents via EMS with palpitations and near syncope. She was driving on the highway today when she had to stop due to abrupt palpitations, SOB, and sensation like she was about to “black out”.

EKG:
Picture
EKG Interpretation:
Sinus rhythm with monomorphic PVCs in pattern of bigeminy. Horizontal axis. Inverted T-waves in inferolateral leads (II, III, aVF, V5-V6). Machine says to consider INFEROLATERAL ISCHEMIA.

Discussion:
Is this ischemia? No. Patient is young and otherwise healthy with no risk factors for cardiovascular disease. She has a history of frequent ventricular ectopy, and presentation is concerning for transient ventricular tachycardia. Pattern of T-wave inversions is consistent with “Cardiac Memory”. How to differentiate:

·   Clinical scenario not consistent with ACS
·   Negative T-waves in same leads where PVCs are negative
·   Eventual resolution after resumption of normal electrical activation

Extent and duration of effect correlates with duration of preceding abnormal ventricular conduction. The longer and more profound the electrical disturbance, the longer and more profound Cardiac Memory persists. Most commonly seen with: 
1) Ventricular pacing
2) Intermittent LBBB
3) Pre-excitation in WPW
4) Episodes of ventricular ventricular tachycardia (likely cause in our patient).

Management:
·   High index of suspicion for underlying pathology
·   Provider awareness of phenomenon so as not to initiate unnecessary interventions (Cath lab, etc.)
·   Treatment aimed at underlying derangement as appropriate
·   Inpatient vs. outpatient continuous cardiac monitoring if diagnosis in question

By Dr. Blake Johnson
0 Comments

Your comment will be posted after it is approved.


Leave a Reply.

    EKG Challenge

    Picture

    Author

    ER residents on Dr. Littmann's cardiology service present an interesting EKG and core concepts from Dr. Littmann.

    Subscribe to Blog
    Littmann's EKG Pearls
    Videos Of Littmann's Lectures

    Archives

    January 2016
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015

    Categories

    All
    Afib
    AIVR
    Aortic Stenosis
    Atrial Flutter
    AVR Sign
    Bifascicular Block
    Cardiac Tamponade
    CHF
    Dextrocardia
    HCOM
    High Lateral MI
    Hyperkalemia
    LAFB
    Paced Rhythms
    Pulmonary Hypertension
    PVC
    Respiratory Distress
    Short QT
    South African Flag Sign
    STEMI
    WPW

    Disclaimer: All EKG's and images are the sole property of CMC Emergency Medicine Residency and cannot be reproduced without written consent.  Patient identifiers have been redacted/changed or patient consent has been obtained.  Information contained in this blog is the opinion of the authors and application of material contained in this blog is at the discretion of the practitioner to verify for accuracy.

    RSS Feed

Powered by Create your own unique website with customizable templates.
  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction