Cardiac Arrest at the airport, with an easy but important ECG for everyone to recognize

 Written by Pendell MeyersEvery once in a while we need to go back and cover some easy but important ECGs.This will be far too easy for most readers of this blog, so please go find a learner and show them this case. Make sure they understand this case well, so that they will be able to learn from the harder versions of this case.A middle aged female suffered sudden witnessed cardiac arrest at the airport, with quick bystander CPR.EMS arrived and found her in VF. She was successfully defibrillated.Her EMS ECG on the way to the ED was sent to us:What do you think?There is likely sinus tachycardia with a prolonged PR interval. Some learners might be worried about VT initially, if they do not recognize the QRS. Instead it is RBBB and LAFB. There is striking concordant STE in V2-V4 that is easy and unmistakable in this case, but often times is much harder to recognize when the J point is not quite as pronounced as it is in this case (see harder cases below).This pattern is one of the highest risk OMI patterns recordable on an ECG: it is large proximal LAD occlusion until proven otherwise. The LAD supplies the anterior septum where the right bundle branch and left anterior fascicle are located. Acute proximal LAD occlusion can cause ischemia of these fascicles causing the combination of RBBB and LAFB. See below for review and references.The cath lab was activated, and the patient fortunately suffered no further arrests. She was of course found to have an ostial LAD occlusion t...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs