View source for Weekly EP & ECG rounds at the BIDMC

'''Editors-In-Chief:''' Chris Pickett,M.D.; Peter Zimetbaum, M.D.; Mark Josephson, M.D.

View more EP & ECG rounds: [[Weekly EP & ECG rounds at the BIDMC (Archive)‎|Weekly EP & ECG rounds at the BIDMC (Archive)‎]]

==July 2008==
'''58 year old female admitted to the hospital with shortness of breath for "rule out MI protocol". Cardiac enzymes negative and echo demonstrates normal cardiac structure and function.'''

'''Two days following admission: development of chest pain and dyspnea.'''

'''This is her ECG on presentation:'''
[[Image:ECG on presentation BI rounds July08 v2.jpg|left|600px]]
{{clr}}

'''This is her ECG on day #2 associated with chest pain and dyspnea:'''
[[Image:ECG day 2 BI rounds July08.jpg|left|600px]]
{{clr}}

'''What is the rhythm and other relevant findings?'''
#Ventricular Tachycardia
#Atrial fibrillation
#Atrial Flutter
#Acute MI
#1 and 4
#2 and 4

[[Rhythm and other relevant findings answer (July 2008)|Click here for the answer]]

'''The patient had ongoing chest pain and now complained of right flank pain. She was transferred emergently to the cardiac catheterization laboratory where the angiogram demonstrated:'''

[[Image:Angiogram BI rounds July08.jpg|left|600px]]
{{clr}}

'''The LAD was treated with thrombectomy and placement of a DES.'''

'''Abdominal CT scan confirmed evidence of a right renal infarction. The likely diagnosis was AF related emboli to the LAD and Kidney.'''


'''The presumption was that AF had reverted to sinus rhythm prior to the initial day of hospitalization and as atrial mechanical function returned a left atrial appendage clot dislodged.'''


'''The cardiac index at the time of PCI was 1.3 and the peak CK reached 11,000.'''


'''This is her ECG on presentation:'''
[[Image:ECG after PCI of LAD July08.jpg|left|600px]]
{{clr}}

'''Why is there RBBB and LAFB and does this require a temporary pacemaker?'''

[[RBBB and LAFB and temporary pacemaker answer (July 2008)|Click here for the answer]]


'''This is her telemetry 24 hours after PCI of proximal LAD:'''
[[Image:Telemetry 24 after PCI BI rounds July08.jpg|left|600px]]
{{clr}}
'''Note the retrograde conduction.'''


'''What is the diagnosis and mechanism of this bradyarrhythmia?'''
#Complete heart block in the AV node
#Complete heart block in the His bundle
#Paroxysmal AV block

[[Diagnosis and mechanism of this bradyarrhythmia answer (July 2008)|Click here for the answer]]

[[category:Electrophysiology]]

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