Rhythm & Rate 8

R_0008_A    is from a middle aged man with chest pain and dizziness.

The second rhythm strip (R_0008_B) was taken soon after the first rhythm, when the patient became unresponsive and had a brief tonic-clonic seizure.

The third rhythm strips (R_0008_C) shows:
A.  The rhythm before and after cardioversion
B.  The rhythm that developed 15 seconds after cardioversion
C.  The rhythm that was present 2 minutes after the cardioversion.
The patient had a palpable pulse when the tracings in B and C were recorded.

Describe the rhythms in this case

Faint-hearted at Flinders Street

What are we seeking when we look at an ECG?  We may be looking for normality,  or for findings that confirm or support our clinical suspicion.  Often we find changes that are “non-specific” or else   are clear-cut but are unrelated to the current problem.  Perhaps we should call the latter changes “distractors”.  This case highlights some of these issues.


Thanks to Mathew Adamson for   this interesting case that he managed on 16th September 2015.

The patient is a 91 year old man with a past history of atrial fibrillation, permanent pacemaker,  and a left internal iliac artery aneurysm that had been coiled.  His medications included citalopram, digoxin, atorvastatin, frusemide, atenolol, rabeprazole, allopurinol and nizatidine.