Does this T wave pattern mean anything?
Written by Michael Doyle DO and Timothy Palmieri MD. Edited by Bracey, Meyers, Grauer, and SmithA 50-something-year-old female with a history of an unknown
personality disorder and alcohol use disorder arrived via EMS following cardiac arrest with return
of spontaneous circulation. The described rhythm was an irregular, wide complex
rhythm. By EMS report, open pill bottles were found nearby at the scene, including quetiapine, fluoxetine, hydroxyzine, and gabapentin. She was successfully revived
after several rounds of ACLS including defibrillation and amiodarone.On arrival to the ED the patient was intubated with normal vital
signs. An Initial ECG was performed: Initial ECG:Sinus tachycardia with prolonged QT interval (QTc of 534 ms by Bazett). No ischemic ST changes.She was given magnesium empirically. Initial serum potassium level was 3.5 mEq/L, though the result was hemolyzed and was potentially lower than reported. Serum ionized calcium and magnesium levels were within normal limits.A repeat ECG was performed 2 hours after arrival: QTc prolongation ato 722 ms now with alternating T wave pattern (T wave alternans)I texted this to Smith who responded:“T wave alternans and long QT. Portends Torsades de Pointes”The patient was given additional magnesium and started on an
infusion of magnesium and a goal of high normal electrolyte repletion. She was
admitted to the ICU where subsequent ECGs were performed:ECG at 12 hoursQTc prolongation, resolution of T wave...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Bracey Source Type: blogs
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