This is Part 2 of Chest pain, acute STEMI, and EMS-witnessed VF arrest.
Let’s take another look at the patient’s heart rhythm.
I can see why some of you thought this was Torsades de Pointes but the cyclic rate is over 300 and the underlying rhythm showed a normal QTc. It’s not unusual for the onset of VF to have a cyclic rate close to 300 and then accelerate to as high as 600 or 700.
I feel confident this is VF. Either way, it was pulseless.
The patient was shocked at 200 J.
Here is a 12-lead ECG of the post-shock rhythm.
I find it interesting that the limb leads become non-diagnostic during accelerated idioventricular rhythm (AIVR).
Several minutes and later the rhythm had stabilized.
The patient was delivered to a PCI-hospital where the interventional cardiologist was waiting.
Here is the 12-lead ECG captured prior to the procedure.
Here is the 12-lead ECG after stenting of the LCX.
These are the days that make it all worth while! Thanks for sharing the case, Phil.