Case 100

Look at the consecutive ECGs in this patient. What is the problem that causes the arrhythmia in rhythm strip 2? (Answer below)

Rhythm strip 1

Rhythm strip 2

Rhythm strip 3

Rhythm strip 4

Answer

• The first rhythm strip shows sinusrhythm with a severely prolonged QT interval. In total four ventricular premature beats are present on this strip. All fall within the T wave of the previous sinus beat.
• The second strip shows Torsade de Pointes with a typical short (not shown) - long - short initial sequence.
• The third ECG shows severe QT prolongation with a stretched QT segment and small T wave, consistent with Type 2 LQTS.
• The fourth ECG shows the same patient later in time.