Every second counts: giant ECG abnormality after every second beat

Clinical introduction The patient had recently been diagnosed with heart failure and dilated cardiomyopathy (left ventricular ejection fraction: 20%). Medication included furosemide, spironolactone, bisoprolol, perindopril, indapamide. The patient was found with a cardiac arrest. After successful basic life support and stabilized circulation, the following ECG was recorded (see figure 1). Question What is the possible explanation for these ECG features? Giant TU waves due to proarrhythmic effect of propafenone (Class 1/c antiarrhythmic drug) the patient was given as paroxysmal atrial fibrillation rhythm control. Hypokalaemia-induced TU wave alterans. artefact on ECG bigemin premature ventricular beats.(figure 1)? Answer:B There are giant negative TU waves after every second QRS complexes most prominent in V3-5 leads. This can be a key ECG finding as warning sign before life threatening ventricular arrhythmias (torsade-de-pointes ventricular tachycardia). This phenomenon is easily mistaken as...
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: EMJ Image Challenge Source Type: research