# Cardiac Case...



## bakertaylor28 (Aug 8, 2017)

A 38-year-old male patient presents with palpitations and SOB. He is not suffering from syncope or dizziness and has no other complaints. The  history bears no peculiarities. Auscultation is normal and there are no signs of left or right heart failure.

The ecg is depicted here: http://imgur.com/a/MBZZD

Vital Signs:

HR: 69
BP: 130 / 92
SpO2: 95
Resp: 16 

What underlying condition do we suspect, and what are our immediate treatment considerations?


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## EpiEMS (Aug 8, 2017)

Any history on this patient? Is the pulse regular?


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## bakertaylor28 (Aug 8, 2017)

EpiEMS said:


> Any history on this patient? Is the pulse regular?


As the OP said, the history bears no peculiarities. (meaning there is no applicable history.)


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## photog (Aug 8, 2017)

Pulmonary embolism. RV strain pattern in ECG.


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## bakertaylor28 (Aug 8, 2017)

photog said:


> Pulmonary embolism. RV strain pattern in ECG.



Very Good, but is PE the only possible cause of RV strain in a previously and largely asymptomatic individual?


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## photog (Aug 8, 2017)

bakertaylor28 said:


> Very Good, but is PE the only possible cause of RV strain in a previously and largely asymptomatic individual?



Certainly not the only cause. (Could also be mitral stenosis,Tetralogy of Fallot etc.)  But together with presumably sudden onset of SOB and palpitations (propably due to those unifocal VES's, which again might be due to PE) and an SpO2 barely in the normal limits it would be my guess.

And if the patient had been immobilized for some reason, had a recent surgery (preferably orthopedic), was a smoker or had a long flight in the near history, that would point to PE even stronger.

However, nothing much to do in the field. Pt is stable and pain free. Hospital will continue with labs.


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## bakertaylor28 (Aug 8, 2017)

photog said:


> Certainly not the only cause. But together with SOB and palpitations (propably due to those unifocal VES's, which again might be due to PE) and an SpO2 barely in the normal limits it would be my guess.
> 
> And if the patient had been immobilized for some reason, had a recent surgery (preferably orthopedic), was a smoker or had a long flight in the near history, that would point to PE even stronger.
> 
> However, nothing much to do in the field. Pt is stable and pain free. Hospital will continue with labs.



Great Work. This case turned out NOT to be a PE. In short the ecg demonstrates a sinus rhythm with ventricular extrasystoles originating in the RVOT (one of them interpolated) with retrograde penetrance in the AV node. The ST-T segment abnormalities in combination with the extrasystole’s origin suggest the presence of ARVC.


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## photog (Aug 8, 2017)

Very interesting case, thank you!


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## Mantis Toboggan (Aug 10, 2017)

OP source: http://en.ecgpedia.org/wiki/Puzzle_2007_1_33_Answer

additional case studies: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2153466/


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