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Stress test to VFib

by on March 31, 2011

EMS crew responded to a Heart Center for a 62 year old male Asian patient. Pt was found laying supine on floor beside a treadmill. He had a abrasion to upper lip. Staff at the heart center stated that this patient came in for his first visit to establish baseline stats. He was in the process of performing his stress test when he collapsed. Staff stated he went into VFib and was immediately defibrillated and had successful conversion with just one shock.

He is now fully alert and oriented and states he feels very well. He has no pain, no shortness of breath and no N/V.

He has been given no medication prior to EMS arrival.

PMH:
Bypass in 1996
CAD
Hyperlipidemia
Uncontrolled Hypertension

Medications:
Bupropion HCI
Lisinopril-Hydrochlorothiazide
Metoporlol succinate
Zyprexia

NKDA

I was able to obtain some of the EKG from the medical center that witnessed the arrest.
Going into VFib

Defibrillation

Post Defibrillation

EMS Crew 12 Lead

This patient was transported to a PCI center and went straight to Cath Lab.

What is your interpretation and treatment?

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From → Case File

7 Comments
  1. That post-defib EKG is absolutely bizzarre. Almost like short-QT due to hypercalcemia? I wonder if that distortion is due to the frequency filter set up on their machines.

    Inferior axis, prolonged QTc, hyperacute T waves, and elevation in the anterior leads with inferiolateral depression suggests acute MI. It might meet voltage criteria for LVH (and show a strain pattern), but the guy went into VF during a stress test, but I’d err on the side of STEMI.

    Pads, consider antiarrhythmics, ASA, safe and expeditious transport to a PCI center.

  2. Thanks for the great case, Tom!

    I think it’s just big LVH. STEMI is certainly possible, but I don’t think so. I would do a bedside echo and look for anterior wall motion abnormality. I don’t think we would see one.

    Let us know the outcome!!

  3. This isn’t my case, Dr. Smith! I just knew you’d be interested because the post-arrest 12-lead ECG shows LVH with a secondary ST/T abnormality.

    Tom

  4. VinceD permalink

    Hmm, like Christopher, I’m very much perplexed by strip immediately post-cardioversion. I don’t know anything about different filter settings, so I suppose that’s a possibility.

    Just throwing this out there, but I want to say it looks like some sort of intraventricular delay with non-existent T-waves. Anyone have some insight?

  5. Nelson permalink

    ST-T abnormalities aside, I kinda see delta waves in there… (more visible in aVF, V4-V6 in that final two 12 lead ekgs)… WPW plus sinus tach may well be the cause for that V-Tach… I’m thinking accessory pathway trouble 🙂 …

  6. Troy permalink

    I would definitely consider LVH. I would err on the side of caution and call this a cardiac patient but the STE seems proportional to the S wave depression.

    The only thing i would add is therapeutic hypothermia. The question i have is i understand the STD in I and aVL in LVH but i dont know if that also includes II, III, and aVF like here. I dont think i’d activate the cath lab but definitely inform the hospital.

    I

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