Giant Inverted T waves in an Elderly Patient

This is another contribution from Victoria Stephen.  Victoria is a third year EM Registrar from at the University of the Witwatersrand in Johannesburg, South Africa, and a great asset to FOAMed.  Follow her on Twitter: @EMcardiac.Here is her previous contribution: Pulseless ventricular tachycardia – why did the AED not advise a shock?  CaseA 91 year old presented to the ED of a small hospital with a history of sudden onset syncope. A family member thought she was having a seizure. She reported no chest pain or dyspnoea when conscious. The patient had a history of hypertension which was poorly controlled.She appeared alert and well-oriented. Her initial BP was 184/90, HR 41 BPM. An ECG was recorded in the ED:There is a complete heart block with a HR of 41 BPM. The QRS complex is 144ms indicating an infranodal escape. There is an RBBB configuration with a LAFB, indicating it may be originate from the left posterior hemi-fascicle. The QTc is significantly prolonged at 535 ms. There are deep wide bizarre looking T waves seen in virtually all the leads, but most notably in the precordial leads.She had a CT of the Brain which showed no intracranial bleed. Her renal function was normal and the electrolytes including calcium and magnesium were normal. Two troponin I were increased at 140 ng/L (0.14 ng/mL) and 70 ng/L (0.070 ng/mL) on consecutive days, (negative is less than 40 ng/L for this assay). Two days later she was referred to a regi...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs